Club & Contact Details

Club Name *

Physical Address

Street Address *
Suburb
Town/City *

Postal Address

Address *
Suburb
Town/City *
Post Code *

Other Club Details

Club Type *
Exercise Facility Over 300 members
Small Exercise Facility Under 300 members
Other Exercise Providers e.g. Yoga studio, PT studio, Other studios such as Pilates or Vibration, Sole Trader such as PT or Yoga Teacher
Website
Email Address *
Phone (landline) *

Application Contact Details

First Name *
Last Name *
Email Address *
Phone (mobile) *