Main Membership Form – Colours Culture Club

Colours Culture Club - Body Culture Membership Form

Main Membership Form

PERSONAL DETAILS

First Name

Last Name

ID Number

Date of Birth

Gender

Phone Number

Address Line 1

Address Line 2

Suburb

Province

Zip Code

Country

EMERGENCY DETAILS

Emergency Contact Name

Emergency Contact Last Name

Emergency Contact Phone Number

MEDICAL INFORMATION

Medical Aid Company

Medical Aid Number

Medical Aid Main Member First Name

Medical Aid Main Member Last Name

Medical Aid Main Member Number

Medical Conditions / Allergies (Optional)

REGISTRATION & MEMBERSHIP

50% off Strength & Body Conditioning sessions.

Mid-Year Membership

Colours Culture Club Individual Membership - R600

SELECT A CCC BODY KIT (Included with Membership)

CCC BODY KIT SIZE

What is your level of running?

Walker

Beginner

Intermediate

Advanced

OPTIONAL APPAREL (Available to order with your membership)

CCC Cap (Optional) - R250

CCC Peak (Optional) - R250

CCC Shorts (Optional) - R500

CCC Tights (Optional) - R550

HEALTHY LIVING (Optional)

Please note: There's a once-off initial assessment charge of R150 for Strength & Body Conditioning. Please tick the box below to include the assessment fee.

FITNESS & EXERCISE

YOUTH & COMMUNITY DEVELOPMENT

NUTRITION & SUPPLEMENTS

Initial Assessment: We look at how you move, how strong you are, and what you’re feeling to understand what’s loading the painful area. We’ll talk through your running goals and build a plan that supports your rehab — and it also makes sure you’re ready to join our movement classes safely - R150 once off.

No payment items has been selected yet

Once payment is received, your apparel will be ready for collection at the CCC Clubhouse.

I have read and agree to the Colours Culture Club Disclaimer.