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NEW LICENSE
Request
Application Details
Firstname:
Address:
Surname:
Home Club:
D.O.B:
Contact No.
Email:
KKA Number:
EKF Number:
Emergency Contact Details
Name:
Address:
Contact Number:
Declaration to be completed by applicant or parent / guardian
I agree for myself or my child to be photographed or used on the website for promotional use only. Please untick if you do not with for your child or yourself to be photographed.
Signature (please type name)
Date:
Status:
Pay by:
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