New College Gym Membership Form (Only for college students & college staffs.)

Gym Membership is only for College Students & College Staff
Important Notice for Student : A student can apply Monthly,Quarterly, Half Yearly, Yearly .  
Don't just fill the membership form, mention the duration of membership if you not want to apply and pay the fee, through challan or other means.
 
Membership Type :  
:  
Name :      
Father's Name :      
Date of Birth (dd-MM-yyyy) :      
Address :  
Gender:  
Body Weight (Kg) :  
E-Mail id:    
Mobile No:  
Any Medical Problem :  
Select Preferred Time Slot :  
Membership Plan :  
Membership Fee : 0.00
Payment Method :