Membership RegistrationShaolin Kickboxing Annual Membership (£55)£55.00Select Your Payment CycleAnnual Membership FeeNextPreviousMembership Application * Username * First Name * Last Name * Email Address * Mobile Phone Number * PasswordStrength: Very Weak * Home Address * Date of birth * Occupation * Weight (KGs)* Instructor's nameSelect OptionKingsleyGerryMollyNeil * Instructor's name* Your goalsLose weightGet fitterLearn to defend yourselfFight competitivelyOther (Specify below) Goals (Other)Medical ConditionsAsthmaEpilepsyDiabetesOther (Specify below) Medical Conditions (Other) Please specify any medication you are taking* Upload a profile picture (less than 2 MB)Done(Use Cropper to set image and use mouse scroller for zoom image.)Done(Use Cropper to set image and use mouse scroller for zoom image.)Drop file here or click to select. Select Your Payment GatewayPaypalHow you want to pay?Auto Debit PaymentManual PaymentPayment SummaryYour currently selected plan : , Plan Amount : Submit
