Surname

Forename(s)

Full address and city

Postcode

Landline telephone number

Mobile telephone number

Email address (please enter carefully)

Date of birth (dd/mm/yyyy)

City of birth

Gender
MaleFemale

Emergency contact name

Emergency telephone number

Emergency relationship (wife/husband etc)

New member or renewal
New MemberRenewal

Membership number (for renewals, if known)

Are you a first claim member of, or have you been a member of any other athletic club?
(Please give as much detail as possible, joining/leaving dates etc)

Vest size (new members choose required size, existing members choose Not Required) Mens Small, 36 inchMens Medium, 38 inchMens Large, 40 inchMens XL, 42 inchMens XXL, 44 inchLadies 8 / XS, 32 inchLadies 10 / Small, 34 inchLadies 12 / Medium, 36 inchLadies 14 Large, 38 inchLadies 16 / XL, 40 inchNot required / Renewal

Method of payment you will be using ChequeBank TransferStanding OrderPaypal

Note: Once you have submitted this form, please visit the 'How to Pay' page to submit your payment.

I agree that I am an amateur as defined by England Athletics. I agree to abide by the rules and conditions of membership as laid down by the Committee of the Club and I agree to abide by the Laws of England Athletics and any other Association to which the Club is affiliated.

I agree that the Club will in no way be held responsible for any injury or illness incurred to my person during or as a result of my participation in club events.

I agree that the Club will retain a computer record of the personal data which I have provided on this form

I agree to the above statements

Note: please be aware that membership applications are usually dealt with and processed within 14 days of payment being recieved and confirmed. But as everyone who deals with your application; Membership Secretary, Treasurer, Kit Sales etc are all volunteers who give their time for free, there may be a delay, especially during holiday periods. We thank you in advance for your patience.