Llanelli Amateur Athletic Club
Membership Renewal 2018
Full name……………………………………………………………………………………………………………………………………..
Address………………………………………………………………………………………………………………………………………..
Post Code…………………Telephone No………………………………………Mobile No…………………………………..
e-mail address…………………………………………………………………………………………………………………………….
Date of Birth………………………………………..Welsh Athletics Registration No…………………………………….
Are you currently suffering from a medical condition? YES/NO Please also complete the reverse
The current subscription fees & Welsh Athletics Registration fees are shown overleaf
I hereby apply to renew my membership of Llanelli Athletic Club and agree to comply with the rules of UK Athletics and Welsh Athletics. I accept that I take part in club activities at my own risk.
Signature…………………………………Parent/Guardian signature if under 16……………………………………...
Membership fees (including Welsh Athletics Registration) received in full.
Signature…………………………………………………….Treasurer
“When you become a member of or renew your membership with Llanelli AAC you will automatically be registered as a member of Welsh Athletics. We will provide Welsh Athletics with your personal data which they will use to enable access to an online portal for you (called MYATHLETICS). Welsh Athletics will contact you to invite you to sign into and update your MYATHLETICS portal (which, amongst other things, allows you to set and amend your privacy settings)”
Signature…………………….Parent/Guardian signature if under 16……………………
Subscription Rates Club Welsh Athletics Fee Total
Senior £17.50 £17.50 £35
Under 20/Under17 £15 £10 £25
Under 15/Under 13 £12.50 £10 £22.50
Under 11 £12.50 £10 £22.50
Family Membership £30 + Welsh Athletics fee – see Secretary or Treasurer for full details
In line with recommendations from UK Athletics (Governing Body for Athletics) on the screening of prospective club members, please could you answer the questions below:
1. Has your doctor ever advised you not to take vigorous exercise?
2. Do you have any ongoing medical problems; diabetes, asthma etc?
3. Are you currently taking any medication?
4. Do you suffer from any significant allergies or allergic reaction to specific drugs? YES / NO
If yes, please note any symptoms experienced when an allergic episode occurs.
What treatment has been necessary in the past?
Contact details of next of kin if an emergency should arise:
NAME:…………………………………………….. TELEPHONE NO:…………………………………..