EMG Event Registration Form

Please answer all the questions using the word none if not applicable:

E-mail Address: *
Your Name: *
Company Name: *
Company Telephone Number: *
Mobile No. (For use on day of event only)
Event Date: *
Event Code: (4 digit number) *
Next of Kin Name: (Person to be contacted in the event of an emergency) *
Next of Kin Contact Number *
Do you suffer from any of the following:Heart Condition, Asthma, Epilepsy, Allergies, Other relevant condition: If yes please give details and instruction for any special medication: If No enter None *
Do you suffer from any of the following injuries or recurring medical conditions: If YES please give details: Neck, Spine, Hips, Knees, Other: If No enter None *
Sex: *
If female are you pregnant:
Can you swim? (Marine activities only)
Size of Clothing: (For Wet Weather Clothing) *
Do you have any specific dietary requirements? If YES please give details: If No enter None: *
Any other comments:
I believe, to the best of my knowledge, all information to be correct. *	Yes No


* Required

.....

emg.co.uk