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Membership Form

If you wish to join the club, it is easiest to download a copy of the form below as a Word file on which you can type your details (a signature is then not needed). Then either bring it with your cheque to the AGM, or present both to the treasurer Loraine Fozzard ASAP. Alternatively please forward the form by email to the club at
southwellrc@hotmail.com and pay your subs by BACS (details are given on the form).
To access the form please click here

SOUTHWELL RUNNING CLUB

MEMBERSHIP FORM

Subscriptions:

All first claim member's subscription (including English Athletics Registration Fee) 30.00

All second claim and student members 18.00     Associate (non-running) members 10.00

Membership will run from April 01 to Mar 31

PLEASE COMPLETE IN BLOCK CAPITALS AND PAY EITHER BY CHEQUE (PAYABLE TO SOUTHWELL RUNNING CLUB) OR BY BACS




  First Name(s)

  Last Name

  Date of Birth


  Address











  Postcode


  Telephone Number (including STD code)


  E-mail address
  (used to send out club newsletters etc)


  Is this your first claim club?  (Yes or No)


  If no, who is your first claim club?


  Date (of application to join SRC)


  Add Club T-shirt (22), Vest (22),
  Sweater (25.50) or Hoody (28.50)
 
  Please circle your requirements

T-shirt   /   Vest  /  Sweater  /  Hoody

Ladies:    Small  /  Medium  /  Large

Mens:    Medium  /  Large  /  X Large

 
  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.

  When you become a member of or renew your membership with Southwell Running Club you will automatically be
  registered as a member of England Athletics. We will provide England Athletics with your personal data which they will
  use to enable access to an online portal for you (called MyAthletics). England Athletics will contact you to invite you to
  sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy
  settings). If you have any questions about the continuing privacy of your personal data when it is shared with England
  Athletics, please contact dataprotection@englandathletics.org


  SIGNED (if handwritten) _______________________________



 

 
 

 

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