EmailMe Form - Idle Athletic Club - Membership Application Form

Idle Athletic Club - Membership Application Form
1. You may join us as a First Claim or Second Claim Member.
2. Membership year runs from April to March each year.
3. Renewing members’ Fees are to be paid by the end of April for the new membership year.
4. Existing members not renewing their membership before the 30th of June will have their membership cancelled as their membership will
have lapsed. You will no longer be able to compete as an Idle AC member and you will not be covered by the clubs insurance. Any competitions entered after lapse of membership will be liable to the extra £2.00 unattached levy.
5 Membership includes social membership to Hepworth & Idle Cricket Club.
6. You will be eligible for the club’s annual ballot for a London marathon entry (conditions apply)
7. Cost of membership is £29.00 for the year.
8. New Members pay £15 for 1st year only

Contact & Personal Information

(Compulsory fields are marked with a red *)

Salutation *

Mrs

Miss

Name *

Prefix

First *

Last *

Suffix

Age *

Must be over 18 yrs

Date of Birth *

YYYY

Address *

Town *

Post Code *

Home Phone Number *

Mobile Phone Number

Email Address *

Confirm *

Dual Club Membership

If you are a member of another running club, please enter the club name here & tick your 1st claim club

First Claim Club?

Idle AC

other club

Activities/Disciplines

Road Running

Cross Country

Fell Running

Trail Running

Cycling

Swimming

Please tick all that apply

Medical Declaration

Are you registered Disabled? *

Yes

Do you hold a valid
First Aid Certificate *

Yes

Emergency Contact Name *

Emergency Phone Number *

Do you have any known medical conditions ?

Do you carry any medication with you ? *

Yes

Are there any emergency procedures of which we should be aware of ?

Declaration *

I confirm that I am eligible to compete under UKA Rules

I accept that my personal information will be held on a computer for by the club

I agree to the disclosure of my personal information to the committee and our sports governing body

Electronic Signature

As acceptance of signature tick the box below & enter your initials in the space provided

I accept the terms & conditions of Idle Athletic Club

Yes, I Accept

Initials

IMPORTANT PAYMENT INFORMATION

Cheques payable to "Idle AC" & given to the Treasurer, Phil Joyner or any committee member.

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