Dallam Running Club – membership application/renewal form st
page 1
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Membership year 1 April 2017 to 31 March 2018 Please read notes on page 2 before completing this form First applicant Name
Date of Birth
Address & Postcode
Home/mob phone
Email Address
Basic club membership is £ 5 each for those included in this application/renewal who are age 18 and over on 1st April 2017. 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 2017 and wish/do not wish to be registered with EA at an additional £14 see page 2 Notes.
+ £ 14
Name and relationship of Emergency Contact
Phone number
Partners or other family members included in this application/renewal Name
Date of Birth
Club membership England Athletics registration
£5 +£14
Name
Date of Birth
Club membership England Athletics registration
£5 +£14
Name
Date of Birth
Club membership England Athletics registration
£5 +£14
Total for new application/renewal of Dallam Running Club membership ,including any additional England Athletics fees Signed
£
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. Parents or guardians are also asked to provide and update information about any relevant medical conditions or injuries personally and in confidence to the Junior Co-ordinators for any of their children who attend Monday evening sessions. Please make cheques payable to “Dallam Running Club” and send with form to the Club Treasurer, Steve Jeffs, 1 Sedgwick Court,Off Cart Lane,Grange over Sands,Cumbria LA11 7AB ,Telephone 015395 35401
page 2
1. England Athletics Registration – those wishing to can be registered with England Athletics for 2017/8 for £14 in addition to the basic club fee. EA registration is not a requirement to join Dallam Running Club but please note the following: - registering with England Athletics via the club is one of the criteria that needs to be met in order to be considered for our London Marathon place(s) available for those aged 18 and over - see further
details on club website - there are other benefits of being registered with England Athletics, particularly if you plan to regularly participate in road races/cross country events. For some races, such as UKA organised events, being a member of England Athletics is a requirement - please check entry details carefully. For more information on England Athletics and receiving a competition licence, please visit http://www.englandathletics.org/england-athletics/athlete-registration
- if you wish to count in either the 2017 English or the British fell running championships, then you must either be a member of the FRA or registered with England Athletics
2. Under 18s – while Dallam Running Club membership is free for anyone under 18 on 1st April 2017 we still need you to complete this form or apply online so that we have your contact details , parental consent and can register you with England Athletics if required (at the additional £14 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 been a member of another running club in the past please provide the name of the club and the date on which you resigned. 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