Title: †Mr/Mrs/Miss/Ms/Dr / England Athletics Registration No:
†First Name(s): / †Gender: Male/Female
†Surname: / †Date of Birth:
(If your details are the same as last year, you can write in this space “As Before” but please remember to add your name, tick your Membership Box and sign and date at the bottom.)
†Postcode: / Tel.No: / Mobile:
LancsCounty Qualification by: (Please ‘Tick’ relevant box)
9 months continuous residence? / Born in Lancashire?
If you are a new member to WRR, ANDhave been a member of another club, have you officially resigned from that club by completing the EA Change of Club forms? / Yes
Membership: (1st January 2016 to 31st December 2016)
Full Competitive (Age 18+) £26[] * Second Claim (Age 18+)£13[] ** Social (Age 18+) £10[]
Intermediate Competitive (Age 11+) £14[]*** Intermediate Social (Age 11+) Free [] ***
Junior Competitive (Age 11-) £5[] ***Junior Social (Age 11-) Free [] ***
(Please ‘Tick’ whichever is applicable)
Cheque payable to Wesham Road Runnersor byBank Transfer- please ask below for details.
Completed form to be returned to: Peter Earnshaw,Membership Secretary,
29 Winsford Crescent, Thornton-Cleveleys, FY5 1PS
or hand it to him at club meetings
or email to:
Please READ and complete below as appropriate:
I understand that my personal data will be held on a computer by the club.
I confirm that I am eligible to compete under UK Athletic Rules. (See below *) / Yes/No
I understand that the personal information marked with † above will be passed to England Athletics for my Registration and Competition Licence card.
(Parent/Guardian for those Under 18) / Date:


† England Athletics requires this minimum information when you are registered as a WRR club member.

* Membership shall be open to person(s) who are amateurs as defined by England Athletics and are aged 18 years or over.

Wesham Road Runners is an 18+ Club. Full membership competitive includes £13 for registration with England Athletics and your Competition Licence Card. This is an increase of £1 on 2015.

** Second Claim excludes registration with England Athleticsand Competition Licence Card

***Membership for children under 18 years will only be considered if they are accompanied by parent(s) or guardian(s) and they are prepared to accept total responsibility for their children whilst attending club meetings and at races. The club does not have appropriate, separate changing/shower facilities which are now considered to be essential. It also does not have the appropriate Child Protection Officers. Competitive membership includes £12 for registration with England Athletics.