Competition Form

Competition form

Date of Birth

Day * 01020304050607080910111213141516171819202122232425262728293031

Month * JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year * 193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001

First Name *

Surname *

Mobile Phone Number *

Email Address *

Preferred Leisure Centre * Please selectBramcote Leisure CentreChilwell OlympiaKimberley Leisure Centre

Are you an existing member?

Yes

No

I am interested in a gym membership and would like you to contact me in the new year

This information will be used in accordance with our Privacy Notice