CROWBOROUGH RUNNERS

APPLICATION FOR MEMBERSHIP

PLEASE COMPLETE IN CAPITALS

SURNAME .......................................................................... MR/MRS/MS/MISS/OTHER ……..

FIRST NAME(S) .....................................................................................................................................

IF UNDER 18, PLEASE SUPPLY PARENT/GUARDIAN’S NAME AND CONTACT DETAILS

CONTACT NAME ……………………………………… ………RELATION TO RUNNER ……………………

ADDRESS ......................................................................................................................................

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PHONE NOS: HOME..................................................................... MOBILE.....................................

E-MAIL ......................................................................................................................................

RUNNER’S DATE OF BIRTH ………...…………… COUNTY OF BIRTH .......................................

If member of another Athletics club(s), give name(s)/county ...........................................................

If member of another club do you agree to running for Crowborough as first claim club Y/N

MEDICAL DETAILS ( REQUIRED FOR THOSE UNDER 18 ) :

DOCTOR’S NAME ……………………………………………………………………………………….

SURGERY AND CONTACT NUMBER …………………………………………………………………

ALLERGIES OR SPECIAL NEEDS……………………………………………………………………..

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Annual Membership Fees – Due 1^st September, pro-rata for those joining during the year

Adult-£12.50, Under 18/Student £6, 1 adult & 1 child - £16, 2 adults & 2 children - £30

I enclose a cheque / postal order / cash for £.................. as my membership fee.

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I wish to participate in: ROAD RUNNING - CROSS COUNTRY - TRACK & FIELD –

(Circle as applicable) JOGGING FOR FUN / FITNESS - POWER WALKING

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I apply for membership of Crowborough Runners and agree to abide by its rules at all times.

I declare that I am an amateur as defined by the club rules.

UNDER 18s : PARENT/GUARDIAN - Please sign below to declare that you are aware that your child trains with Crowborough Runners at their own risk, that he or she is, to the best of your knowledge well and fit enough to participate in physical activity and that you will ensure that suitable footwear and clothing appropriate for the weather is worn . Please also note that you are responsible for the delivery and collection of your child at the agreed times and that club rules and trainer’s instructions must be followed.

Signed...................................................................................... Date………………………………

Please bring the completed form along to Tuesday training night at the Goldsmiths Leisure centre track, with Membership fees, in a named envelope. Or send to Julie Harker, Salcombe, Mottins Hill, Crowborough, TN6 3SE

DATA PROTECTION: it is our policy NOT to disclose individual’s personal details to third parties. Information supplied will be kept on file by the Membership Secretary (and, for juniors, the Club’s Junior Development Officer) for emergency contact and membership records purposes only.