T.A.G.B. Annual Licence Renewal Form

Student Name *

First

Last

Students Date of Birth *

Students Home Address *

Address Line 1

City

State / Province / Region

Postal Code

Mobile Contact Number *

Email Address *

Email

Confirm Email

Emergency Contact 1 - Name *

Emergency Contact 1 - Mobile Number *

Emergency Contact 2 - Name *

Emergency Contact 2 - Mobile Number *

Does the student suffer from any medical conditions that may affect their training? *

If Yes Please Give Details

Does the student suffer from any physical injuries or disabilities that may affect their training? *

If Yes Please Give Details

Has the student ever been convicted or cautioned of a criminal act? *

If Yes Please Give Details

Renewal Payment *

I acknowledge that a fee of £38.00 is due with reference to this renewal.
I acknowledge that this application and payment are due no later than 20th of the month, after this date the renewal will increases to £43.00
I acknowledge the application will not be completed until the payment is made.

TAGB Declaration & Privacy Statement *

TAGB Privacy Policy *

BTC Insurance Details *

Full Name of Person Submitting this form *

Annual Licence Renewal

Price: £38.00

Total *

£0.00

Stripe Credit Card *