Membership Form
To download a copy of the form as a Word file on which you can type your details, please click here
SOUTHWELL RUNNING CLUB
MEMBERSHIP FORM
Annual Subscriptions:
Club Subscription (including English Athletics Registration Fee) £20.00
Aged 60 and over £17.00 Second claim members £12.00
Under 18's
or in full time education £10.00
Associate (non-running) members £5.00
Membership runs from September 01 to August 31 each year
PLEASE COMPLETE IN BLOCK CAPITALS AND RETURN WITH YOUR CHEQUE (PAYABLE TO SOUTHWELL RUNNING CLUB) TO BARBARA GARRETT EITHER AT THE AGM OR ASAP
(ADDRESS: 1 The Brickyard, Broadgate Lane, Kelham, Newark, Notts NG23 5RY)
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First Name(s) |
Last Name |
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Date of Birth |
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Address |
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Postcode |
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| Telephone Number (including
STD code) |
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| E-mail address (used to send out club newsletters etc) |
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| Is this your
first claim club (Yes or No) |
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| If no, who is your first claim club? |
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| Date (of application to join
SRC) |
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Add Club T-shirt (£22), Vest (£22), Sweater (£25.50) or Hoody (£28.50) (Ladies sizes - Small, Medium or Large) Mens sizes - Medium, Large, X-large) Please circle your requirements |
Ladies: Small /
Medium /Large
Mens:
Medium / Large / X-Large
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I certify that the information given above is correct. I have read the guidelines for SRC and agree to abide by them. I declare that I am an amateur as defined by the UK Athletics rules and that I will abide by these rules. I am medically fit and understand that I participate/enter in any club activities/events entirely at my own risk.I agree that Southwell Running Club shall not be liable for any accidents, injury, loss, damage or claim or expense that may arise in consequence of my participation in club activities/events. SIGNED _______________________________ |
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MCAA state that data will be maintained in accordance with the Data Protection Act and will only be used for internal purposes. It will not be disclosed to third parties