| EA
No.
Lytham
St. Anne's Road Runners Club
APPLICATION
FOR JUNIOR MEMBERSHIP
| Forename/s |
Title |
| Surname |
Date
of Birth |
| Address |
Home
tel. |
|
|
Work
tel. |
|
|
Mobile
tel. |
| Postcode |
Email |
Other athletics clubs of which you are
(or have been) a member
| Club
name |
1st
or 2nd claim |
Date
of resignation |
|
|
|
|
|
|
|
|
Disciplines
in which you expect to participate (Tick as appropriate)
| Road
Running |
Cross-Country |
Track
& Field |
Fell
Running |
I
agree to abide by U.K. Athletics rules: Signature_____________________________________
Date ___/___/___
JUNIOR
(Under 18) MEMBERSHIP
In consideration of your acceptance of my son's/daughter's* membership,
I hereby accept that neither Lytham St. Anne's Road Runners Club nor its
Officers or Committee shall be liable for any accident, injury, loss or
damage sustained by my son/daughter*, or caused by him/her*, when participating
in any Club activities including training runs or representing the Club
in races. I accept the Club is not responsible for my son's/daughter's*
travel arrangements to training sessions and races. *Delete
as appropriate.
Signature
of parent or guardian __________________________________________________
Date
___/___/___
DATA
PROTECTION ACT (All to complete this declaration)
The information given on this form is kept on the clubs only database
for administration purposes. Your personal details will be disclosed on
the membership list and to England Athletics to give you the rights
to compete in events.
I
give/do not give** permission for this information to be stored on the
clubs only data base.
I
give/do not give** permission for disclosure of my son / daughter personal
details to England Athletics.
**Delete as appropriate.
Signature (parent or guardian if under 18) _________________________________
Date ___/___/___
Please
return this form to the Membership Secretary (Mel Koth) with your annual
subscription:
Junior
11-u20: £7.50, Junior: 8-11 £5
________________________________________________________________________________
For
office use
Membership
fee of £ ____ for year ending 31/12/09 received from ___________________________
| Junior
(11 +) |
Junior
( 8-11 ) |
Receipt
issued ____/____/____
Accepted
by Committee ____/____/____ Signed ___________________________
|