{"id":309,"date":"2025-01-18T19:19:44","date_gmt":"2025-01-18T19:19:44","guid":{"rendered":"https:\/\/topgunboxing.co.za\/?page_id=309"},"modified":"2025-01-18T19:35:11","modified_gmt":"2025-01-18T19:35:11","slug":"top-gun-unlimited-group-class-6-months-membership","status":"publish","type":"page","link":"https:\/\/topgunboxing.co.za\/?page_id=309","title":{"rendered":"Top Gun, Unlimited Group Class, 6 Months Membership"},"content":{"rendered":"<style id=\"wpforms-css-vars-305\">\n\t\t\t\t#wpforms-305 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style>\r\n<style type=\"text\/css\">\r\n\r\n\r\n\r\nbody #wpforms-305 {\r\n\t\t\r\n\t\t\tfont-family:inherit;}\r\n\r\n\t\r\n\r\n\tbody #wpforms-305 .wpforms-head-container {\r\n\t\tborder-width: 0px;}\r\n\r\n\tbody #wpforms-305 .wpforms-head-container .wpforms-title {\r\n\tcolor:#ffffff ;\t}\r\n\r\n\tbody #wpforms-305 .wpforms-head-container .wpforms-description {\r\n\t\tcolor:#ffffff ;\t\tdisplay:block;\r\n\t}\r\n\r\n\r\n\tbody #wpforms-305 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#wpforms-305 label.wpforms-error,\r\n\tbody #wpforms-305 .wpforms-error[role=\"alert\"] {\r\n\t\tbackground-color:#000000 ;\r\n\t\t\t\tborder-width: 1px;\t}\r\n\/* Styling for Tablets *\/\r\n@media only screen and (max-width: 800px) and (min-width:481px) {\r\n\t\r\n\r\n\r\n\r\n}\r\n\r\n@media only screen and (max-width: 480px){\r\n\t\r\n\r\n\r\n\r\n}\r\n\/*Option to add custom CSS *\/\r\n\r\n\r\n\r\n\t\t<\/style>\r\n\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-305\"><form id=\"wpforms-form-305\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"305\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F309\" data-token=\"f94b2d95b90467fd4c125c0ec6dc91b7\" data-token-time=\"1776294930\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-305-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-305-field_1-error\" required><label for=\"wpforms-305-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-305-field_1-last-error\" required><label for=\"wpforms-305-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-305-field_3-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_3\">Date of Birth<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_3\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][3][date]\" aria-errormessage=\"wpforms-305-field_3-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_2-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_2\">ID Number<\/label><input type=\"number\" id=\"wpforms-305-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" step=\"any\" aria-errormessage=\"wpforms-305-field_2-error\" ><\/div><div id=\"wpforms-305-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_4\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-305-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" aria-errormessage=\"wpforms-305-field_4-error\" aria-describedby=\"wpforms-305-field_4-description\" required><div id=\"wpforms-305-field_4-description\" class=\"wpforms-field-description\">The Agreement Reference Number will be emailed to this email address. <\/div><\/div><div id=\"wpforms-305-field_11-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_11\">Phone<\/label><input type=\"tel\" id=\"wpforms-305-field_11\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][11]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-305-field_11-error\" ><\/div><div id=\"wpforms-305-field_5-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_5\">Start Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_5\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][5][date]\" aria-errormessage=\"wpforms-305-field_5-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_10-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact Person <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_10\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][10][first]\" aria-errormessage=\"wpforms-305-field_10-error\" required><label for=\"wpforms-305-field_10\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_10-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][10][last]\" aria-errormessage=\"wpforms-305-field_10-last-error\" required><label for=\"wpforms-305-field_10-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-305-field_48-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_48\">Emergency Contact Person&#039;s Number<\/label><input type=\"tel\" id=\"wpforms-305-field_48\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][48]\" aria-label=\"Emergency Contact Person&#039;s Number\" aria-errormessage=\"wpforms-305-field_48-error\" ><\/div><div id=\"wpforms-305-field_50-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_50\">Alternative Emergency Contact  Number if available<\/label><input type=\"tel\" id=\"wpforms-305-field_50\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][50]\" aria-label=\"Alternative Emergency Contact  Number if available\" aria-errormessage=\"wpforms-305-field_50-error\" ><\/div><div id=\"wpforms-305-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_49\">Relationship to Emergency Contact Person<\/label><input type=\"text\" id=\"wpforms-305-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-305-field_49-error\" ><\/div><div id=\"wpforms-305-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Would you like the Top Gun, Unlimited Group Class, 6 Months Membership, at R1500 per month? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-305-field_15_1\" name=\"wpforms[fields][15]\" value=\"Yes\" aria-errormessage=\"wpforms-305-field_15_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_15_1\">Yes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_18-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Which of these conditions or diseases have you ever suffered from any?<\/legend><ul id=\"wpforms-305-field_18\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_1\" name=\"wpforms[fields][18][]\" value=\"Stroke\" aria-errormessage=\"wpforms-305-field_18_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_1\">Stroke<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_2\" name=\"wpforms[fields][18][]\" value=\"High Cholesterol\" aria-errormessage=\"wpforms-305-field_18_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_2\">High Cholesterol<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_3\" name=\"wpforms[fields][18][]\" value=\"Intermittent Claudication (leg cramps)\" aria-errormessage=\"wpforms-305-field_18_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_3\">Intermittent Claudication (leg cramps)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_6\" name=\"wpforms[fields][18][]\" value=\"High Blood Pressure\" aria-errormessage=\"wpforms-305-field_18_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_6\">High Blood Pressure<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_7\" name=\"wpforms[fields][18][]\" value=\"Diabetes\" aria-errormessage=\"wpforms-305-field_18_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_7\">Diabetes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_8\" name=\"wpforms[fields][18][]\" value=\"Shortness of breath\" aria-errormessage=\"wpforms-305-field_18_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_8\">Shortness of breath<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_9\" name=\"wpforms[fields][18][]\" value=\"Heart Disease\" aria-errormessage=\"wpforms-305-field_18_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_9\">Heart Disease<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_10\" name=\"wpforms[fields][18][]\" value=\"Cancer\" aria-errormessage=\"wpforms-305-field_18_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_10\">Cancer<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_11\" name=\"wpforms[fields][18][]\" value=\"Chest pain\" aria-errormessage=\"wpforms-305-field_18_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_11\">Chest pain<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_12\" name=\"wpforms[fields][18][]\" value=\"Lung Disease\" aria-errormessage=\"wpforms-305-field_18_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_12\">Lung Disease<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_13\" name=\"wpforms[fields][18][]\" value=\"Asthma\" aria-errormessage=\"wpforms-305-field_18_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_13\">Asthma<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_14\" name=\"wpforms[fields][18][]\" value=\"Ankle swelling\" aria-errormessage=\"wpforms-305-field_18_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_14\">Ankle swelling<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_15\" name=\"wpforms[fields][18][]\" value=\"Peripheral Vascular Disease\" aria-errormessage=\"wpforms-305-field_18_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_15\">Peripheral Vascular Disease<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_16\" name=\"wpforms[fields][18][]\" value=\"Palpitations\" aria-errormessage=\"wpforms-305-field_18_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_16\">Palpitations<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_17\" name=\"wpforms[fields][18][]\" value=\"Frequent fainting or dizzy spells\" aria-errormessage=\"wpforms-305-field_18_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_17\">Frequent fainting or dizzy spells<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_18_18\" name=\"wpforms[fields][18][]\" value=\"Other\" aria-errormessage=\"wpforms-305-field_18_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_18_18\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_19-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_19\">What is the conditions or diseases that you have suffered from?<\/label><input type=\"text\" id=\"wpforms-305-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-305-field_19-error\" ><\/div><div id=\"wpforms-305-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_20\">Given by (Name of Bank Account Holder):<\/label><input type=\"text\" id=\"wpforms-305-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-305-field_20-error\" aria-describedby=\"wpforms-305-field_20-description\" ><div id=\"wpforms-305-field_20-description\" class=\"wpforms-field-description\">Top Gun Boxing Gym (Pty) Ltd _ Authority\/Mandate: Paper\/Electronic\n<\/div><\/div><div id=\"wpforms-305-field_26-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_26\">Physical Address:<\/label><textarea id=\"wpforms-305-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-305-field_26-error\" ><\/textarea><\/div><div id=\"wpforms-305-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_29\">Bank Name:<\/label><input type=\"text\" id=\"wpforms-305-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-305-field_29-error\" ><\/div><div id=\"wpforms-305-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_30\">Branch Name \/ Branch Code<\/label><input type=\"text\" id=\"wpforms-305-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-305-field_30-error\" ><\/div><div id=\"wpforms-305-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_31\">Account Number<\/label><input type=\"text\" id=\"wpforms-305-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-305-field_31-error\" ><\/div><div id=\"wpforms-305-field_32-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">Type of Account<\/legend><ul id=\"wpforms-305-field_32\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-305-field_32_1\" name=\"wpforms[fields][32]\" value=\"Current (cheque)\" aria-errormessage=\"wpforms-305-field_32_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_32_1\">Current (cheque)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-305-field_32_2\" name=\"wpforms[fields][32]\" value=\"Savings\" aria-errormessage=\"wpforms-305-field_32_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_32_2\">Savings<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-305-field_32_3\" name=\"wpforms[fields][32]\" value=\"Transmission\" aria-errormessage=\"wpforms-305-field_32_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_32_3\">Transmission<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_33-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_33\">Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_33\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][33][date]\" aria-errormessage=\"wpforms-305-field_33-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_34-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_34\">Contact Number<\/label><input type=\"tel\" id=\"wpforms-305-field_34\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][34]\" aria-label=\"Contact Number\" aria-errormessage=\"wpforms-305-field_34-error\" ><\/div><div id=\"wpforms-305-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_55\">Amount<\/label><input type=\"text\" id=\"wpforms-305-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-305-field_55-error\" ><\/div><div id=\"wpforms-305-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_36\">To<\/label><input type=\"text\" id=\"wpforms-305-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-305-field_36-error\" aria-describedby=\"wpforms-305-field_36-description\" ><div id=\"wpforms-305-field_36-description\" class=\"wpforms-field-description\">Name of Beneficiary<\/div><\/div><div id=\"wpforms-305-field_37-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_37\">Address<\/label><textarea id=\"wpforms-305-field_37\" class=\"wpforms-field-medium\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-305-field_37-error\" ><\/textarea><\/div><div id=\"wpforms-305-field_38-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"38\"><fieldset><legend class=\"wpforms-field-label\">Abbreviated Short name to be used:<\/legend><ul id=\"wpforms-305-field_38\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_38_1\" name=\"wpforms[fields][38][]\" value=\"TOPGUNBOX\" aria-errormessage=\"wpforms-305-field_38_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_38_1\">TOPGUNBOX<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_39-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"39\"><fieldset><legend class=\"wpforms-field-label\">Netcash Authorisation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_39\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-305-field_39_1\" name=\"wpforms[fields][39]\" value=\"I\/We hereby authorise Netcash (Pty) Ltd to issue and deliver payment instructions to your banker for collection against  my\/our abovementioned account at my\/our abovementioned bank on condition that the sum of such payment instructions  will not differ from my\/our obligations as agreed to in the Contract Reference Number.  The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of  the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement.  The payment instructions so authorised to be issued must carry the Contract Reference Number, included in the said payment instructions, and must be provided to identify the specific contract. The said Contract Reference Number should be added to this form in section E before the issuing of any payment instruction and communicated directly after having been completed.\" aria-errormessage=\"wpforms-305-field_39_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_39_1\">I\/We hereby authorise Netcash (Pty) Ltd to issue and deliver payment instructions to your banker for collection against  my\/our abovementioned account at my\/our abovementioned bank on condition that the sum of such payment instructions  will not differ from my\/our obligations as agreed to in the Contract Reference Number.  The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of  the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement.  The payment instructions so authorised to be issued must carry the Contract Reference Number, included in the said payment instructions, and must be provided to identify the specific contract. The said Contract Reference Number should be added to this form in section E before the issuing of any payment instruction and communicated directly after having been completed.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_40-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_40\">I \/we agree that the first payment instruction will be issued and delivered on<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_40\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][40][date]\" aria-errormessage=\"wpforms-305-field_40-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_41-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_41\">After the first payment instruction has been issued and delivered, we authorise thereafter, monthly debit orders on the selected day below:<\/label><select id=\"wpforms-305-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\"><option value=\"1st\"  class=\"choice-1 depth-1\"  >1st<\/option><option value=\"2nd\"  class=\"choice-2 depth-1\"  >2nd<\/option><option value=\"3rd\"  class=\"choice-3 depth-1\"  >3rd<\/option><option value=\"4th\"  class=\"choice-4 depth-1\"  >4th<\/option><option value=\"5th\"  class=\"choice-5 depth-1\"  >5th<\/option><option value=\"6th\"  class=\"choice-6 depth-1\"  >6th<\/option><option value=\"7th\"  class=\"choice-7 depth-1\"  >7th<\/option><option value=\"8th\"  class=\"choice-8 depth-1\"  >8th<\/option><option value=\"9th\"  class=\"choice-9 depth-1\"  >9th<\/option><option value=\"10th\"  class=\"choice-10 depth-1\"  >10th<\/option><option value=\"11th\"  class=\"choice-11 depth-1\"  >11th<\/option><option value=\"12th\"  class=\"choice-12 depth-1\"  >12th<\/option><option value=\"13th\"  class=\"choice-13 depth-1\"  >13th<\/option><option value=\"14th\"  class=\"choice-14 depth-1\"  >14th<\/option><option value=\"15th\"  class=\"choice-15 depth-1\"  >15th<\/option><option value=\"16th\"  class=\"choice-16 depth-1\"  >16th<\/option><option value=\"17th\"  class=\"choice-17 depth-1\"  >17th<\/option><option value=\"18th\"  class=\"choice-18 depth-1\"  >18th<\/option><option value=\"19th\"  class=\"choice-19 depth-1\"  >19th<\/option><option value=\"20th\"  class=\"choice-20 depth-1\"  >20th<\/option><option value=\"21st\"  class=\"choice-21 depth-1\"  >21st<\/option><option value=\"22nd\"  class=\"choice-22 depth-1\"  >22nd<\/option><option value=\"23rd\"  class=\"choice-23 depth-1\"  >23rd<\/option><option value=\"24th\"  class=\"choice-24 depth-1\"  >24th<\/option><option value=\"25th\"  class=\"choice-25 depth-1\"  >25th<\/option><option value=\"26th\"  class=\"choice-26 depth-1\"  >26th<\/option><option value=\"27th\"  class=\"choice-28 depth-1\"  >27th<\/option><option value=\"28th\"  class=\"choice-29 depth-1\"  >28th<\/option><option value=\"29th\"  class=\"choice-30 depth-1\"  >29th<\/option><option value=\"30th\"  class=\"choice-31 depth-1\"  >30th<\/option><option value=\"31st\"  class=\"choice-32 depth-1\"  >31st<\/option><\/select><\/div><div id=\"wpforms-305-field_42-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to agree alternate debit day when needed. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_42_1\" name=\"wpforms[fields][42][]\" value=\"I agree to that, if however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or  Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me\/us by giving you notice in writing of not less than the  interval (as indicated in the previous clause) and   sent by prepaid registered post or delivered to your address indicated above.\" aria-errormessage=\"wpforms-305-field_42_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_42_1\">I agree to that, if however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or  Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me\/us by giving you notice in writing of not less than the  interval (as indicated in the previous clause) and   sent by prepaid registered post or delivered to your address indicated above.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_43-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to ensure fund availability <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_43_1\" name=\"wpforms[fields][43][]\" value=\"I undertake to ensure that funds will be available and authorise TopGunBox to re-submit the debit and\/or implement tracking on this account and collect funds as soon as they are available if the debit is unsuccessful.  I acknowledge that the bank may charge additional fees for resubmission or failed transaction or disputed transactions, and TopBunBox may recover such fees from me which may amount from a minimum of R50.00 (Fifty Rand).  I acknowledge that I am not entitled to any refund while this authority is in force, if such amounts were legally owing to TopGunBox  I authorise TopGunBox to disclose to any credit bureau any information concerning this credit profile and payment history.\" aria-errormessage=\"wpforms-305-field_43_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_43_1\">I undertake to ensure that funds will be available and authorise TopGunBox to re-submit the debit and\/or implement tracking on this account and collect funds as soon as they are available if the debit is unsuccessful.  I acknowledge that the bank may charge additional fees for resubmission or failed transaction or disputed transactions, and TopBunBox may recover such fees from me which may amount from a minimum of R50.00 (Fifty Rand).  I acknowledge that I am not entitled to any refund while this authority is in force, if such amounts were legally owing to TopGunBox  I authorise TopGunBox to disclose to any credit bureau any information concerning this credit profile and payment history.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_44-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to agree to the Mandate <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_44_1\" name=\"wpforms[fields][44][]\" value=\"I\/we acknowledge that all payment instructions issued by you will be treated by my\/our abovementioned bank as if the instructions had been issued by me\/ us personally.\" aria-errormessage=\"wpforms-305-field_44_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_44_1\">I\/we acknowledge that all payment instructions issued by you will be treated by my\/our abovementioned bank as if the instructions had been issued by me\/ us personally.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_45-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to agree to our Cancellation Policy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_45\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_45_1\" name=\"wpforms[fields][45][]\" value=\"Missed classes cannot be made up or carried over into another month and this agreement cannot be suspended for any period of time unless due to exceptional circumstances such as serious injury ill health. In such circumstances, TopGunBox may at its sole discretion, agree to to pause this agreement for up to a maximum of three months (such medical evidence in support thereof to be provided by myself). Thereafter, ordinary membership fees shall apply. This Agreement cannot be put on hold over or due to holiday periods, including but not limited to religious and\/or student holidays.  I\/we agree that although this authority and mandate may be cancelled by me\/us, such cancellation      will not cancel the  Agreement. I\/we also understand that I\/we cannot reclaim amounts, which have been withdrawn from my\/our account (paid)  in terms of this authority and mandate if such amounts were legally owing to you, unless paid for upfront by cash or card  I \/we agree to be liable to pay the pro-rated amount for the remaining months of the contract, as stipulated in the terms of the agreement I \/we signed. This means that members will be required to pay for all remaining months based on the contract\u2019s original duration, which amount\/s shall become due and payable immediately  All Top Gun Boxing gym members are required to provide a minimum of one month&#039;s notice before cancelation of contract.  Upon receiving the notice, a pro-rated cancellation fee will be applied based on the remaining term of the contract.  Notwithstanding the above, TopGunBox may terminate my membership and\/or this Agreement at the end of any given month for any reason whatsoever, and may suspend my membership and access to their facilities with immediate effect prior to such termination for any reason whatsoever. In such circumstances, TopGunBox will refund a pro rate portion of any fees paid for the applicable month.\" aria-errormessage=\"wpforms-305-field_45_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_45_1\">Missed classes cannot be made up or carried over into another month and this agreement cannot be suspended for any period of time unless due to exceptional circumstances such as serious injury ill health. In such circumstances, TopGunBox may at its sole discretion, agree to to pause this agreement for up to a maximum of three months (such medical evidence in support thereof to be provided by myself). Thereafter, ordinary membership fees shall apply. This Agreement cannot be put on hold over or due to holiday periods, including but not limited to religious and\/or student holidays.  I\/we agree that although this authority and mandate may be cancelled by me\/us, such cancellation      will not cancel the  Agreement. I\/we also understand that I\/we cannot reclaim amounts, which have been withdrawn from my\/our account (paid)  in terms of this authority and mandate if such amounts were legally owing to you, unless paid for upfront by cash or card  I \/we agree to be liable to pay the pro-rated amount for the remaining months of the contract, as stipulated in the terms of the agreement I \/we signed. This means that members will be required to pay for all remaining months based on the contract\u2019s original duration, which amount\/s shall become due and payable immediately  All Top Gun Boxing gym members are required to provide a minimum of one month's notice before cancelation of contract.  Upon receiving the notice, a pro-rated cancellation fee will be applied based on the remaining term of the contract.  Notwithstanding the above, TopGunBox may terminate my membership and\/or this Agreement at the end of any given month for any reason whatsoever, and may suspend my membership and access to their facilities with immediate effect prior to such termination for any reason whatsoever. In such circumstances, TopGunBox will refund a pro rate portion of any fees paid for the applicable month.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_46-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to agree to our Liability Policy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_46\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_46_1\" name=\"wpforms[fields][46][]\" value=\"I agree that TopGunbox, it\u2019s directors, employees, representatives, and\/or agents shall not be liable for any personal injuries, damage or loss of personal property for any reason whatsoever.  I agree and understand that notwithstanding any consultation on exercise programs, methods and\/or types of equipment, which may be provided by TOpGunBox and\/or it\u2019s employees and\/or agents (\u201cthe services\u201d) , my selection and\/or use of such exercise programs, methods and\/or types of equipment shall be my sole responsibility and TopGunBox, it\u2019s directors, employees, representative and\/or agents shall not be liable to myself or any third party for any claims, demands, injuries, damages or actions arising due to unjury to me and\/or any third person or property for any reason whatsoever, arising out of or in connection with the use of the services, equipment and\/or facilities of TopGunBox or the premises where TopGun Box is located.  By signature of this Agreement by myself and\/or my legal guardian and\/or primary care giver duly authorized, I release and discharge TopGunBox, its successors, assigns, officers, directors, employes, representatives and agents from all claims demands, injuries, damages, actions, losses and expenses.   I agree that this section and all of its provisions will survive any cancellation of this agreement.  I also agree that the provisions of this Agreement shall be deemed severable and the invalidity or unenforceability of any provision of this Agreement shall not affect the validity or unenforceability of any of the other\/remaining provisions of same.\" aria-errormessage=\"wpforms-305-field_46_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_46_1\">I agree that TopGunbox, it\u2019s directors, employees, representatives, and\/or agents shall not be liable for any personal injuries, damage or loss of personal property for any reason whatsoever.  I agree and understand that notwithstanding any consultation on exercise programs, methods and\/or types of equipment, which may be provided by TOpGunBox and\/or it\u2019s employees and\/or agents (\u201cthe services\u201d) , my selection and\/or use of such exercise programs, methods and\/or types of equipment shall be my sole responsibility and TopGunBox, it\u2019s directors, employees, representative and\/or agents shall not be liable to myself or any third party for any claims, demands, injuries, damages or actions arising due to unjury to me and\/or any third person or property for any reason whatsoever, arising out of or in connection with the use of the services, equipment and\/or facilities of TopGunBox or the premises where TopGun Box is located.  By signature of this Agreement by myself and\/or my legal guardian and\/or primary care giver duly authorized, I release and discharge TopGunBox, its successors, assigns, officers, directors, employes, representatives and agents from all claims demands, injuries, damages, actions, losses and expenses.   I agree that this section and all of its provisions will survive any cancellation of this agreement.  I also agree that the provisions of this Agreement shall be deemed severable and the invalidity or unenforceability of any provision of this Agreement shall not affect the validity or unenforceability of any of the other\/remaining provisions of same.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-305-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_47\">Declaration of Health: List all your health conditions, illnesses, issues, and injuries:<\/label><textarea id=\"wpforms-305-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-305-field_47-error\" aria-describedby=\"wpforms-305-field_47-description\" ><\/textarea><div id=\"wpforms-305-field_47-description\" class=\"wpforms-field-description\">I undertake to ensure that I consult a medical doctor if necessary prior to participating in any form of exercise at TopGunBox and that I disclose in this Agreement all my history or illness, injuries, or other health related issues in cases of emergency, including but not limited to asthma, epilepsy and heart conditions.<\/div><\/div><div id=\"wpforms-305-field_51-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"51\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to acknowledge the Assignment <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_51\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_51_1\" name=\"wpforms[fields][51][]\" value=\"I\/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to  that third party.\" aria-errormessage=\"wpforms-305-field_51_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_51_1\">I\/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to  that third party.<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-305-field_6-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"6\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-305-field_6\" >the Start be<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-305-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-305-field_52-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\">Select checkbox to confirm the Acceptance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-305-field_52\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_52_1\" name=\"wpforms[fields][52][]\" value=\"I confirm that I have read and understand the terms and conditions of this Agreement and agree to all the terms and conditions stipulated herein, including but not limited to the payment structure, waiver and release of liability, and signed this Agreement with full knowledge of its content.  I further confirm that all details provided by me are accurate and that I have consulted with my physician or doctor prior to commencing training.\" aria-errormessage=\"wpforms-305-field_52_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_52_1\">I confirm that I have read and understand the terms and conditions of this Agreement and agree to all the terms and conditions stipulated herein, including but not limited to the payment structure, waiver and release of liability, and signed this Agreement with full knowledge of its content.  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