MEMBERSHIP FORM 2011/12
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Name |
Date of Birth |
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Address
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Post Code |
Phone number |
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e-mail |
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Country of Birth |
Mr. Mrs.. Miss..Ms.. (please delete) |
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Is the Athlete a member of any other club? Club name and registration number required |
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I declare that the athlete is an amateur as defined by the
UK Athletics Association |
Please sign |
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CLUB MEMBERSHIP: - |
Senior waged (£15.00) |
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Senior unwaged (£10.00) |
2nd Claim(£10.00) |
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Junior (£10.00) |
Family (£30.00) |
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Do you require a vest (what size?) (£15.00) |
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IN ADDITION TO CLUB MEMBERSHIP AND IF YOU COMPETE YOU
MUST JOIN THE WELSH ATHLETICS REGISTRATION SCHEME |
Under 11,13,&15: £7.50 Under 17 &20: £10.00 Seniors & Masters: £15.00 |
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Junior Athletes: - Does the athlete have any medical
condition that we should be aware of? |
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All Athletes: - Do you suffer from Asthma? You need to
register:- |
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Please return the form to Steve Hatfield, |
Official Use only |
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phone 01745 856672 |
Date Joined: - |
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e-mail: stephen-hatfield@hotmail.co.uk |
Welsh Athletics# : - |