Membership Registration – Dolphin Coast Striders

Membership Registration Form

Username* Usernames cannot be changed. Use this name to log-in next time.
First Name*
Nickname* Often the same as first name
Surname*
Mobile Number Please use format e.g. 082 967 2444
ID Number / Passport Number / Birth Certificate Number * Please enter one form if ID, do not include spaces.
E-mail*
Communication consent via email
- No
- Yes
Do you consent to us communicating non-essential media via email? e.g. Newsletters, Special Offers etc.
Communication consent via mobile
- No
- Yes
Do you consent to us communicating non-essential media via mobile?
License ASA Product Purchased
New ASA License Number
Last valid ASA License Number
×The maximum number of fields has been reached.
- ×+
- Upload ASA License (Single)Upload Please upload a .pdf for your completed ASA License form here.
- ×+
- Upload ASA License (Single)Upload Please upload a .pdf for your completed ASA License form here.
Password* Type your password.
Repeat Password* Type your password again.
PARTNER/SPOUSE (If you would like a family membership)
First Name (Partner)
Surname (Partner)
Mobile Number (Partner)
ID Number / Passport Number / Birth Certificate Number (Partner)
E-Mail (Partner)
Communication consent via email (Partner)
- No
- Yes
Communication consent via mobile (Partner)
- No
- Yes
License ASA Product Purchased (Partner)
New ASA License Number (Partner)
Last valid ASA License Number (Partner)
×The maximum number of fields has been reached.
- ×+
- Upload a .pdf fileUpload Please upload a .pdf for your completed partner's ASA License form here.
- ×+
- Upload a .pdf fileUpload Please upload a .pdf for your completed partner's ASA License form here.
CHILDREN/DEPENDENTS (If you would like a family membership)
×The maximum number of fields has been reached.
- ×+
- First Name (Child)
- Surname (Child)
- ID Number (Child)
- Age (Child)
- ASA Lisence New Number (Child) Once purchased.
- ASA License Old Number (Child) If you have one.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child) Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- ×+
- First Name (Child)
- Surname (Child)
- ID Number (Child)
- Age (Child)
- ASA Lisence New Number (Child) Once purchased.
- ASA License Old Number (Child) If you have one.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child) Upload Please upload a .pdf for your completed ASA License form here.
- Upload ASA License (Child)Upload Please upload a .pdf for your completed ASA License form here.
- Billing/Shipping Address
- Country*
- First Name*
- Last Name*
- Company Name
- Address*
- Town / City*
- State / County*
- Postcode / Zip*
- Email Address*
- Phone*
Security Check*
Just to ensure a human is filling out this form.

Send these credentials via email.

If not yet done, please complete the 2021 ASA Permanent License form

If not yet done, please complete 2021 ASA Junior Permanent License forms for each child and upload to their profile sections.

Membership Registration Form

PARTNER/SPOUSE (If you would like a family membership)

CHILDREN/DEPENDENTS (If you would like a family membership)

Billing/Shipping Address