Sunderland Strollers Running Club

Membership Form

Please complete this form in BLOCK capitals or by typing into the spaces provided.

Membership is £25 and can be paid either by cash direct to the Treasurer, cheque payable to Sunderland Strollers or by bank transfer to Sunderland Strollers (09-01-29 - 05585618).

Personal Details

Title / First Name(s) / Last Name
Gender / Date of Birth
Address
Postcode / E-mail Address
Preferred Contact Number
Emergency Contact Name / Contact Number

Membership of other Running Clubs

Running Clubs of which you are a member
Status - 1st / 2nd claim / Date of Resignation from Previous Club

Disciplines in Which You Expect to Compete (please tick)

Road Running / Cross Country / Fell & Off Road

Athletic Coaching Qualifications:-

Level
Event(s)

I agree / do not agree to my personal data being held on a computer by the club and disclosed to English Athletics.

Signed / Date

Please note Sunderland Strollers does not accept membership of anyone under the age of 18.

Please send Membership Form to Treasurer / Membership Secretary:

Gary Hargrave, 19 Richard Avenue, SUNDERLAND, SR4 7LQ