MEMBERSHIP APPLICATION

I, the undersigned, wish to renew/apply for membership of the above Running Club

NAME: …................................................................................................

ADDRESS: ....................................................................................................

....................................................................................................

………………………………………………………………………………..

POST CODE: ....................................................................................................

E-mail Address: (please write clearly)………………………………………………………. 

D.O.B: .....................................................................................................

TEL. NO: .....................................................................................................

For the purposes of communication the Club also holds details of telephone numbers and email addresses. If you do not wish us to hold this information please leave the above blank. If you do not wish this information to be circulated to other members please tick this box.   [  ]

Are you a member of another UK Athletics affiliated club or Swindon Triathlon Club? YES / NO

If ‘YES’ which club? ……………………………………………………………………………….

Do you want Swindon Striders as your 1^st Claim or 2nd Claim? ……………………….

I understand that I must abide by the Rules laid down in the Club Constitution at all times.

SIGNED.....................................................................................

OFFICIAL USE ONLY

AMOUNT RECEIVED £   ......................... PAID TO:      .................................. (Committee Member)

DATE:    ..………/…………/…............ AGE CATEGORY ...................

1stClaim/2nd Claim

RECEIVED MEMBERSHIP CARD …………………...... EMAIL ADDRESS ADDED TO LIST …………