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Personal Details
In order for us to respond to your enquiry please provide full contact details. A telephone number or e-mail address would be most useful, so that we can contact you if we need further details.
Title:
Mr
Mrs
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Ms
Other
Your name:
Home telephone number is:*
Date of Birth:
Mobile telephone number:
Current address:
Your e-mail address:*
Enquiry Details
Please select the Leisure Centre(s) related to your enquiry:
Blidworth Leisure Centre
Dukeries Leisure Centre
Newark Sports and Fitness Centre
Southwell Leisure Centre
Please select your enquiry type:
Active Card sign up
Guest Pass
Membership
Timetables
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Other
...it is important you give as much information as possible.
Data Protection
Any information that is voluntarily submitted through our online forms will only be used for the purpose or purposes for which it was intended.
We may wish to share the information you supply within the business units of Active4today. If you agree to us sharing the information you have provided in this way please tick the box.
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