Please PRINT OUT this Membership Application Form and the Terms and Conditions form and complete in full. Return the completed Application together with the signed Terms and Conditions page to the following address:-

Andy Ward Leisure, 54 Belfast Road, Ballynahinch, County Down, BT24 8EB. T: 028 9756 0033

Surname ________________________________________ First Name ______________________________ Title _________

Address ________________________________________________________________________________________________

Post Code _______________________________ E-Mail ________________________________________________________

Tel (H) ___________________________ Tel (W) ___________________________ Tel (M) ____________________________

Occupation _________________________________________ Employer ___________________________________________

DECLARATION BY MEMBER - I / we apply to become a member/s of Andy Ward Leisure from the period ___________________ to _______________________ I / we declare that I / we are not aware that I / we have any medical conditions which would prevent me / us from engaging in exercise.

Signature _____________________________________________________ Date _______________________________