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Swiss Club WA

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Membership

Swiss Club WA membership application

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First Name *

Last Name *

Occupation

Email Address *

Phone Number

Birthday (example 01/01/1977)

/ / ( dd / mm / yyyy )

Membership Category

Details of Partner (Name)

Details of Partner (Date of Birth)

/ / ( dd / mm / yyyy )

Details of Partner (Occupation)

Detail of first child

Date of birth of first child

/ / ( dd / mm / yyyy )

Detail of second child

Date of birth of second child

/ / ( dd / mm / yyyy )

Details of third child

Date of birth of third child

/ / ( dd / mm / yyyy )

Address (Number Street)

Postcode

Day time phone

Mobile Phone

Details of Children (second)