EA No.

Lytham St. Anne's Road Runners Club

APPLICATION FOR MEMBERSHIP

Other athletics clubs of which you are (or have been) a member

Disciplines in which you expect to participate (Tick as appropriate)

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' database for administration purposes only. 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 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:

First Claim £23 (11-u20 & full-time students £7.50, 8-11 £5); Second Claim £17.

________________________________________________________________________________

For office use

Membership fee of £ ____ for year ending 31/12/09 received from ___________________________

Receipt issued ____/____/____

Accepted by Committee ____/____/____ Signed ___________________________