COGSTATE TEST - REGISTRATION FORM

COGSTATE TEST - REGISTRATION FORM

Each person registering must complete the form, for large groups please contact us separately

Question Title

* 1. Who is registering?

First Name

Surname

Date of Birth

Email Address

Phone number in Dubai

Member of the Dubai Hurricanes Rugby Club?

To take the test at UPANDRUNNING, please select a preferred date and time:

Question Title

* 2. Tuesdays:

	16.30	17.30	18.30
Tue 10 Oct	Tue 10 Oct 16.30	Tue 10 Oct 17.30	Tue 10 Oct 18.30
Tue 17 Oct	Tue 17 Oct 16.30	Tue 17 Oct 17.30	Tue 17 Oct 18.30

Question Title

* 3. Saturdays:

	9.30	10.30
Sat 6 Oct	Sat 6 Oct 9.30	Sat 6 Oct 10.30
Sat 13 Oct	Sat 13 Oct 9.30	Sat 13 Oct 10.30
Sat 20 Oct	Sat 20 Oct 9.30	Sat 20 Oct 10.30