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Gedling Leisure Card Application

Personal Information Gedling Leisure Card Number if Known Title (Ms/Mr) First Name Surname Date of Birth Gender MaleFemale Address Postcode Home Phone Number Mobile Number Email Address Do you consider yourself to have a disability? YesNo Please indicate the category which best describes your ethnic origin White British White Other Irish African Caribbean Black Other Indian Pakistani Bangladeshi Asian Other African-white Mixed Caribbean-white Mixed Asian-white Mixed Chinese Other Prefer not to say