Membership Application

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PERSONAL DETAILS

Please help us to keep accurate records of your valued membership by completing this section in full.

Your Salutation

Your Name

Your Surname

Your Address

Postal Code

Your E-Mail

Your Preferred Contact Number

Date of Birth

Your Occupation

MEMBERSHIP SECTION

Choose your Membership

Details on your selected membership will appear here after you have made a selection from the dropdown list above.

VOLUNTEER STATUS

Are you able to volunteer to assist us?

DISCLAIMER

In consideration of gaining membership or being allowed to participate in the activities and
programme of the YMCA and to use its facilities, equipment, and machinery in addition to the payment
or any fee or charge, I do hereby waive, release, and forever discharge the YMCA Athlone and its
officers, employees, and all others from any and all responsibilities or liability for injuries or damages
resulting from my participation in any activities or my use of equipment or machinery in the above
mentioned facilities or arising out of my participation in any activities at said facility. I agree to adhere
to all policies set by the YMCA and accept that all memberships are non-refundable and not
transferable.

Disclaimer Response

By submitting this form we assume that you have read, understand and agree with the disclaimer and relevant terms and conditions of your membership.