UEA Student - Sportspark Registration Form



PLEASE COMPLETE ALL SECTIONS IN BLOCK CAPITALS

1. Title



*2. Last Name


*3. First Name (s)


*4. UEA Email address


*5. Contact telephone number


6. School of study


*7. To identify how you will use the Sportspark, please tick the most appropriate box.


*8. Year of study


*9. Date of Birth (DD/MM/YY)


*10. UEA Student Number (Above barcode on UEA Student card)


*11. Course Expiration Date (DD/MM/YY) (Under picture on UEA Student card)


*12. Sportspark Number (under barcode on back of UEA Student card)


*13. We would like to send you information about our own sessions and programmes at ueasport and Sportspark, by email. Do you agree to being contacted in this way?