Gym Health Waiver

To register to our gym please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth (Optional)

Sierra Leone Passport Carrier *

No

Yes

Current Position? *

Geology

Mining

Processing

Engineering

Logistics

Finance

Administration

Human Resources

Information Technologies

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Code

Phone

Thanks for submitting!

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