Membership Form 2017 / 2018
Title / Telephone
First name / Mobile
Surname / Date of Birth
Address / Email:
Emergency contact information:
Post Code
Membership category (Please tick) / Specific Club Interests.
Full member (£110) / Cross Country
Student (£50)*U21 or in full-time education / Track & Field
First claim is Trent Park ** / Triathlon / Multi-sports
** If you are currently a member of another running club or your membership expired less than six months ago, you must join us as a second claim member. / First claim club if not Trent Park:
Data Protection Act: The data supplied on this form may be stored electronically. By signing the form you give us permission to do so. This information is used by the club for club purposes. We will not pass this information to any third party or use it for any other purpose.
The Club sends out information to members using the above contact data. Please check the box if you do not want to receive this information.
Make your contact details available to other registered members (telephone / email only) They must sign in to view your contact details, you will not be able to view other member's details unless you agree to your own being available.
Please check this box if you do not wish to make your details available to other members.
*This is a Member’s Club owned and run by its members therefore you are encouraged to volunteer your time or services during the membership year to enable the Club to continue to operate.
*I understand that participation is entirely at my own risk and that the club, including coaches, group leaders and officials, will not be held responsible for any illness, injury or loss of property. I hereby agree to abide by the constitution of the club as well as any rules/regulations of the various governing bodies, leagues and training venues.
* Acceptance is a condition of membership of the club.
Please specify payment method:• Cheque (Made payable to Trent Park Running Club.) • Cash • Bank Transfer
(Sort code: 20-29-77; A/C No: 23522601; Account: Trent Park Running Club Senior Subs.)
If paying by Bank Transfer, you must provide your full name in the Reference.
Please sign and date this form and send it together with payment to:
Neil Kimberley, 42 Hillcrest, Winchmore Hill, London, N21 1AT
Signed / Date