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Form
Gedling Leisure Card Application
Personal Information
Gedling Leisure Card Number if Known
Title (Ms/Mr)
First Name
Surname
Date of Birth
Gender
Male
Female
Address
Postcode
Home Phone Number
Mobile Number
Email Address
Do you consider yourself to have a disability?
Yes
No
Please indicate the category which best describes your ethnic origin
White British
Black Other
African-white Mixed
White Other
Indian
Caribbean-white Mixed
Irish
Pakistani
Asian-white Mixed
African
Bangladeshi
Chinese
Caribbean
Asian Other
Other
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