AKA THAILAND REGISTRATION INFORMATION

AKA THAILAND REGISTRATION INFORMATION

REGISTRATION FORM

Please submit your information below and we will confirm your details by email within 24 hours. If you have any further questions please CONTACT US and we will be happy to provide you with more information.

Name (required)

Surname (required)

Date of Birth (required)

Gender (required)
MaleFemale

Nationality (required)

Country of Residence (required)

Your Email (required)

How did you hear about us? (required)
FacebookInstagramTwitterYouTubeLive FeedGoogleMike SwickFlyersVideosWord of MouthOther

ARRIVAL INFORMATION (OPTIONAL):

Arrival Date (optional)

Arrival Time (optional)

Airline (optional)

Flight Number (optional)

EMERGENCY CONTACT INFORMATION

Primary person to be notified in case of an emergency:

Full Name (optional)

Relationship? (optional)
RelativeFriendSpouseOther

Home Address (optional)

Home Phone (optional)

Word Phone (optional)

Mobile/Cell (optional)

Email (optional)

Secondary person to be notified in case of an emergency:

Full Name (optional)

Relationship? (optional)
RelativeFriendSpouseOther

Home Address (optional)

Home Phone (optional)

Word Phone (optional)

Mobile/Cell (optional)

Email (optional)

INSURANCE INFORMATION (OPTIONAL):

Provider (optional)

Contact Person (optional)

Reference Number (optional)

Phone (optional)

List any medications you take routinely and provide details: (optional)

Details of any medical/mobility conditions that affect you currently or in the past: (optional)

List any allergies that affect you & provide details: (optional)

Any other information that emergency personnel should be aware of: (optional)

Would you like to join our newsletter?
YesNo

The information requested on this form is conditional and for emergency use only. In the event of a medical emergency, this information will be used by AKA Thailand to ensure your safety and wellbeing while in the Kingdom of Thailand. Your medical information is confidential and will not be used for any other purposes.

Please review this form and make sure that all information provided is accurate.

LOCATION MAP

ENQUIRIES & RESERVATIONS

GYM ADDRESS

  • 47/31-32 Moo 4
    Soi Sermsuk, Wiset Road
    Rawai, Phuket 83130
  • 47/31-32 หมู่ที่ 4 ตำบลราไวย์,
    อำเภอเมืองภูเก็ต, จังหวัดภูเก็ต
    83130

GYM OPENING HOURS

  • Monday - Friday: 07:00 - 21:00
  • Saturday: 07:00 - 18:00
  • Sunday: 09:00 - 15:00

SOCIAL MEDIA

AKA THAILAND

  • 47/31-32 Moo 4
    Soi Sermsuk, Wiset Road
    Rawai, Phuket 83130
  • 47/31-32 หมู่ที่ 4 ตำบลราไวย์,
    อำเภอเมืองภูเก็ต, จังหวัดภูเก็ต
    83130

OPENING HOURS

  • Mon - Fri
    07:00 - 21:00
  • Saturday
    07:00 - 18:00
  • Sunday
    Closed

TWITTER FEED