Flinders University Speleological Society Inc.





















Member Registration

Registration Form

If you wish to join our motley underground crew, then please fill out the form below. We will get back to you as soon as our crazy secretary gets over their hangover.

Your Details

Name (First,Last): Mandatory
Address Line 1: Mandatory
Address Line 2: Mandatory
Please Note: The above is where the ASF Newsletter will be sent. The FUSSI newsletters are here
Contact phone1: (home)
Contact phone2: (mobile)
email: Mandatory
Confirm email: Mandatory
Student id: If student at Flinders

Details of next of kin or emergency contact

Name 1) Phone:
Name 2) Phone:
Name 3) Phone:
Address 1)
Address 2)
Address 3)

General Information

Do you hold a current First Aid certificate?
Circle as appropriate Yes No    Expiry date
List any other current medical or first aid qualifications? For example, nurse or volunteer with St Johns or the SA ambulance service: Do you have any medical condition(s) that require(s) medication?
Circle as appropriate Yes No    Medical Alert number
If so, please give details: Take your medication with you whilest underground on a FUSSI trip.
Please inform the trip leader of your medical condition.
Do you consent to having your photo shown on the FUSSI website, or Facebook for PR purposes and general sharing amongst members?
Yes No Comments:

When ready, push->

Valid XHTML 1.0 Transitional


©FUSSI 2014. Email: fussi@fussi.org.au
(to contact us, copy the above address to your favourite email application)