Dallam Running Club 2015 Membership Application/Renewal Form First applicant Name
Date of Birth
Address & Postcode
Home/mob phone
Email Address
page 1
Basic club membership is £ 5 each for those included in this application/renewal who are age 18 and over on 1st January 2015. Club membership is free for u18s but it’s still important that you complete this form so that we have contact details ,parental consent, and know your England Athletics requirements – see page 2 Notes
£5
England Athletics registration I am age 11 or over on 1st April 2015 and wish/do not wish to be registered with EA at an additional £12 see page 2 Notes
+ £ 12
Name and relationship of Emergency Contact Phone number
Partners or other family members included in this application/renewal Name
Name
Name
Name
Date of Birth
Date of Birth
Date of Birth
Date of Birth
Club membership England Athletics registration at an additional £12 Club membership England Athletics registration at an additional £12 Club membership England Athletics registration at an additional £12 Club membership England Athletics registration at an additional £12
Total for new application/renewal of Dallam Running Club membership , incl any England Athletics fees Signed
£5 +£12 £5 +£12 £5 +£12 £5 +£12 £
Date
(and also circle here if signed as *parent or guardian) If you do not agree to give permission for your child’s name/photo or you own name/photo to be used in any press reports that Dallam Running Club may submit to local press or appear on the club’s website please tick here [ ] NB If you are under 18 and applying for individual membership this form must completed and signed by your parent or guardian on your behalf. Please make cheques payable to “Dallam Running Club” and send with form to the Club Treasurer, Paul Sewell , 7 Monkswell Drive,Bolton Le Sands,Carnforth,Lancashire,LA5 8JZ . Telephone 01524 823794
Notes
page 2
1. England Athletics Registration – Members age 11 or over have the option of paying an additional £12 per year to be registered by the club with England Athletics and receive a competition licence which among others thing will mean you pay reduced entry fees for UKA licensed road and multi-terrain events. Read more about club affiliation to England Athletics and the benefits for registered athletes here Benefits for registered athletes “Registration with England Athletics brings a wide variety of benefits for athletes:
Personal profile page on Power of 10 Reduced entry fees for UKA licensed road and multi-terrain events (minimum £2) Sweatshop - £15 off running shoes (one redemption offer valid all year), 10% off all full price shoes and apparel (offer valid all year on unlimited purchases by EA card holder) plus more seasonal offers Nova International - exclusive access to Great Run Club Challenge for affiliated clubs and registered athletes with prize money, free race entries and a trip to the Great Ethiopian Run all up for grabs! Track & Field Tours - special offers on warm weather training trips and packages to major events British Athletics - offers related to major events We also bring you other offers and opportunities from time to time. You will be entitled to discounts on coaching courses including Assistant Coach, Athletics Coach, and Coach in Running Fitness qualifications. Opportunities for you, (and at times your club or your school) to get involved in exclusive events and experiences
And importantly it enables you to opt to receive weekly bulletins on what's happening in the sport including essential information for athletes. To find out more about receiving this information click here. You can learn more about updating your profile to ensure we (England Athletics) send you the information by clicking here.” 2. Under 18s – while Dallam Running Club membership is free for anyone under 18 on 1st January 2015 we still need you to complete this form so that we have your contact details , parental consent and can register you with England Athletics if required (at the additional £12 fee). 3. New members - if you are also a member of another running club please state its name and give your first and second claim preferences. If you have resigned from a previous club please give the date of resignation. 4. Existing Dallam RC members -please help to keep our records accurate and up to date by completing all details including dates of birth, phone and email contacts. Please renew your membership as soon as possible. If your membership lapses, you won’t be eligible for inclusion in our relay teams or receive club communications. If you have any queries about club membership or England Athletics registrations please contact the Club Secretary, David Shinn. email
[email protected] phone 01524 734035
