NEW MEMBERSHIP FORM Jan 17/ Mar 18 /
Name:
Telephone No. / Mobile No.
Address
Postcode:
Email (all club communication is via email)
Date of Birth / Age at 31/12/17: (for age group)
Medical Conditions / Allergies
Emergency Contact details:
Name: / Relationship to member:
Phone /Mobile
Standard Club fees (from 01 Jan 2017 - 31 Mar 2018) 18 years + / £25.00
Youth member fees / £12.50
UK Athletics Affiliation fees (01/04/17 - 31/03/18) (for Road Race License) / £14.00
Payment Vouchers (for club sessions and events) – starter pack of 10
/ £20.00FTC Swim Cap (One Size - Senior=Yellow, Youth=Red) / £5.00
TOTAL
Payment: please make cheques payable to Farnham Triathlon Club and send to:
Cathy Roberts, Membership Secretary, Buckhaven, Arrow Lane, Hartley Wintney, Hants RG27 8LR
Important Information – please read and sign below:
Membership details are stored electronically but not distributed beyond the committee, coaching team
and organisers of Farnham Triathlon Club (FTC) events.
Tick here if you do not want your email address added to the email group ( )
Tick here if you do not want your contact details released to other members
for arranging training sessions, events, ( )
By entering any FTC race I consent to my name, age category and gender being displayed publicly on the results pages of the FTC website.
The club recommends that members consult their doctor before participating in FTC training sessions or competitions. Any medical condition must be noted above.
I acknowledge that triathlon, duathlon, aquathlon, etc. can be dangerous and physically demanding sports and that I participate at my own risk. Neither the club nor the committee will be held responsible for accidents that occur while I participate.
I accept responsibility for notifying the coach of any medical conditions before each coached training session.
I have fully read and agree to abide by the club rules as laid out in the document "Club Rules 2.doc"
The safety and wellbeing of children and young people is paramount and in order to safeguard the junior members of Farnham Triathlon Club we would ask that you complete the following:
1. Have you ever been convicted of a criminal offence which is not spent under the Rehabilitation of Offenders Act 1974? YES / NO *
2. Are you a person known to any social services department as being an actual or potential risk to children? YES / NO *
3. Have you had a disciplinary sanction (from a sports or other organisation's governing body) relating to child abuse? YES / NO *
* Delete as appropriate. If you answer YES to any of the above then our Club Welfare Officer will contact you to discuss further.
Signature: ______Date: ______
Affiliated to / / /