APPLICATION FOR MEMBERSHIP 2008/2009
Please fill in ALL sections.
Name in Full ___________________________________________________
Address ______________________________________________________________________
__________________________________Postcode_________________________
Email Address ________________________@_______________________________
Telephone No. (Home) _______________________ (Work) ____________________________
Telephone No. (Mobile) ____________________________________
Emergency Contact and number details _____________________ _____________________________
Date of Birth ___________________ Age ______ Male or Female ______________
Please State whether First or Second Claim _________________
If Second Claim, please state First Claim club ________________________________________
I wish to become a member of the Wrekin Road Runners for 2008/2009 and declare that I am a bona fide amateur and will abide by Athletics UK rules.
Subject to my membership application being successful, I will abide by the rules in force within the constitution of Wrekin Road Runners. A copy is available from the Membership Secretary.
Signed ________________________________ Date __________________
The above information shall be stored on computer for the purposes of club administration by Wrekin Road Runners, and distributed to members of the club to facilitate contact between them. If you object to the above information being issued to club members or Athletics UK bodies please tick here:
FEES: £15 Full Member (membership until 31st March 2009)
£10 2nd Claim - £3 Social Member
Please post or hand your form and cheque to Denzil Martin (Membership Secretary)
2 Burroughs Bank Lightmoor, Telford, Shropshire. TF4 3QS
Please make cheques payable to: ‘WREKIN ROAD RUNNERS’.
------------------------------------------------------------------------------------------------------------------
OFFICIAL USE ONLY
Received by Membership secretary on (Date) ____________ Signed ________________
Membership Fee received by Treasurer on (Date) ________ Signed ________________
Amount Received £ ___________ (Cash/Cheque)
