Personal Info.

Email:
* Use your student email if applicable

First name:
*

Last name:
*

Password:

• Your password can’t be too similar to your other personal information.
• Your password must contain at least 8 characters.
• Your password can’t be entirely numeric.

Password confirmation:
Enter the same password as before, for verification.

Member type:
Student Staff Alumni Other Not Affiliated *

Date of Birth:
JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303119401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 *

Student ID Number:
*

Mobile Phone Number:
*

Medical/Dietary Info.

Medical Requirements:

Dietary Requirements:

Next of Kin Name:
*

Next of Kin Relation:
*

Next of Kin Phone Number:
*

Next of Kin Address 1:
*

Next of Kin Address 2:

Next of Kin Address 3:

Next of Kin Postcode:
*

Surfing Info.

Ability:
New to surfing Surfing whitewater Surfing green waves Confident surfer Shredding *

I own a Wetsuit:

I own a Large Board:

I own a Shortboard:

I Have a car to drive to trips:

Number of seats in my car (including driver):

I can drive a SUSU Minibus:

Agreements

I can Swim 100m:

I Have Paid Membership (SUSU Box Office):

I agree to the Club Rules:
*