MEMBERSHIP APPLICATION/RENEWAL FORM 2017/18
If you are applying as a new member or renewing and changing your details, this form must be completed and returned, before the start of any activities with the Club, to the Membership Secretary, Upper Thames Rowing Club, Remenham Lane, Remenham, Berkshire, RG9 3DB ().
If renewing and your details are unchanged, please email with your name and details of your payment (either posted cheque or bank transfer as below).
About you:
Title: / Forename(s): / Surname:Work phone: / Home phone: / Mobile: / Date of birth:
Address:
Town: / County: / Postcode:
Email : / School attended (if under 18):
Emergency Contact Details:
Title: / Forename(s): / Surname:Phone number: / Relationship to member:
Membership and Boat Racking categories:
I wish to become a member as indicated below:
Membership Type (exempt from VAT)
Full Rowing: £465 or £380 if renewing and received by 1st October 2017
Full Rowing Member – over 65: £235 or £205 if renewing and received by 1st October 2017
Non-Rowing Associate: £95 or £75 if renewing and received by 1st October 2017
Non-Rowing Joint Associate: £130 or £110 if renewing and received by 1st October 2017
Racking Fees (inclusive of VAT)
Single: £390 or £330 if renewing and received by 1st October 2017
Double/Pair: £770 or £645 if renewing and received by 1st October 2017
Stored in eaves – per seat: £105 or £80 if renewing and received by 1st October 2017
As last year, electronic transfers to the club are preferred; however please ensure that when making the payment you use the following reference: SUBS, your surname, followed by your first name. The bank details are HSBC Bank, Henley on Thames, Sort Code 40-24-10, Account Number 41406507, Upper Thames Rowing Club.
Should you wish to pay by cheque, please make it payable to Upper Thames Rowing Club (UTRC) and send it to: The Membership Secretary, Remenham Lane, Remenham, Berkshire, RG9 3DB, writing on the back of the cheque:
The name of the member the cheque is paying for - particularly key for juniors where the cheque is from a parent, or if it is a company cheque that does not obviously relate to the member.
The breakdown of payment: e.g. full membership plus inside rack, associate member etc.
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The membership year runs from 1st September to 31st August. Discounts on membership may be available if you are unable to afford the membership fees, contact the membership secretary if this applies to you.
Health
The Equality Act 2010 defines a disability as “a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities”.
Do you (or your parent/guardian) consider yourself to have a disability under this definition? [ ] No [ ] Yes
Do you have any other medical condition or injury E.g. epilepsy, diabetes, asthma, allergies? [ ] No [ ] Yes
If you have answered yes to either of the above questions, please give details:
Membership declaration:
I the undersigned confirm that I do not have any medical or physical condition or disability which would either preclude heavy exercise or put me at increased risk while rowing,and that I can swim at least 100 metres in light clothing.
I am aware of (1) BR’s “Row Safe: a guide to good practice in rowing” and its contents (additional information displayed at the Clubhouse and on the Club web site) and (2) UTRC’s data protection policy (see website for details and your right to ask for copies of the information we hold) and consent to UTRC processing my Personal Data as set out in that policy.
I accept that participation is at my own risk and responsibility, and understand that (if under18), in the event of any injury or illness, all reasonable steps will be taken to contact my Parent/Carer and to deal with that injury/illness appropriately.
You should insure yourself (by BR registration) and, if applicable, your equipment (through a recognised Boat Insurance policy).
Signature of Applicant ...... Date......
(Parent or Guardian/Carer if under 18 --- if so, please indicate)
Name (printed) and signature of member proposing application………………………………………………………………..
Name (printed) and signature of member seconding application………………………………………………………………..
I have the following skills to offer the club ………………………………………………………………………………………………….
I am happy to volunteer to help at club events……………………………………………………………………………………………
For boat storage information please contact Peter Taylor at
NB. All private boats must display a current BR number (UTCnnn). Rack Fees include EA licence. Junior rates for U18 only.
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