Membership

Membership Application

Name *

Address 1 *

Address 2

Town *

Postcode *

Mobile Phone *

Home Phone

Emergency Contact Name *

Emergency Contact Phone Number *

Date of Birth *

Email *

Date *

Disclaimer *

By checking this box I declare that I am medically fit and understand that I take part in events at my own risk and will not hold the club or race organisers responsible for any injury, accident or loss or damage to possessions. I understand that any information given above will be held by the club and not used or sold to any companies or third parties with the exception of the England Athletics Association (unless otherwise stated as above) and to race organisers for my agreed entry for a race

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