ANNUAL MEMBERSHIP FORM Please enable JavaScript in your browser to complete this form.Name *FirstLastGender *FemaleMaleOtherDisability *Club Role *Date Of Birth *Mailing Address *Email *Home Number – Input like: 5191234567 – no spaces Cell Phone Number – Input like: 5191234567 – no spaces Work Number – Input like: 5191234567 – no spaces T-shirt Size *Additional information – Health Information and/or Special Considerations (allergies):Emergency Contact *Relationship *Home Phone Number – Input like: 5191234567 – no spaces Cell Phone Number – Input like: 5191234567 – no spaces Work Phone Number – Input like: 5191234567 – no spaces Fee Section – Individual Fee for Annual Membership: $10.00 DUE MAY 31st, 2023 *Individual Fee for Annual Membership: $10.00Payment – E-transfer to: londoncannonballs@gmail.com OR Mail a cheque (Payable to: London Cannonballs) to: 17 Cherokee Rd., London, Ontario N6G 2N7 *E-TransferChequeI, ___________________ (name of participant or parent/guardian), on behalf of __________________ (myself or name of child/ward), hereby consent to the collection and free use of my or my child/ward’s images and athletic results by the London Cannonballs Boccia Club I further understand that this consent may be withdrawn at any time, upon written notice. I give this consent voluntarily. *YesNoName *FirstLastDateSubmit