EXMOUTH HARRIERS
MEMBERSHIP APPLICATION FORM
SECTION A
I, (NAME
IN FULL)
..
apply for membership to the Exmouth
Harriers and, if elected, agree to be bound by the Constitution of Exmouth
Harriers. I certify that I am an amateur
and agree to be bound by the Rules of UK Athletics. My personal details are as follows:
Address:
.
Postcode:
Telephone
number:
..E-mail:
Town
and county of birth:
..Date of Birth:
...
Membership Category: SENIOR (£
*Please
provide details of family members as follows:
|
|
Name |
Date
of Birth |
Male/Female |
|
1 |
|
|
|
|
2 |
|
|
|
|
3 |
|
|
|
|
4 |
|
|
|
I AM/AM NOT a member of another Athletic Club. (Delete as applicable)
If a
member of another Athletic Club, please supply
details:
..
I do/do
not wish to join the Exmouth Harriers E-Mail group (ExmouthHarriers@yahoogroups.com)
to receive information.
Signature of Applicant
.Dated
SECTION
B - CERTIFICATE OF AUTHORITY BY PARENT OR
GUARDIAN THIS SECTION IS ONLY APPLICABLE IF APPLICANT IS UNDER EIGHTEEN
I, (INITIALS/NAME)
do
hereby certify that the details supplied under Section A above are correct to
the best of my knowledge and if accepted I give full consent to the named
applicant becoming a member of Exmouth Harriers and the authority for HIM/HER
to participate in Training and Competition within the sport of Amateur
Athletics.
Signature of Parent/Guardian:
Dated
.
SECTION C INFORMATION SUPPLIED UNDER THIS SECTION WILL BE OF GREAT ASSISTANCE TO
THE CLUB
Please
ring the disciplines that you are interested in:
TRACK
SECTION D (CLUB USE ONLY)
Date
application and subscription received by Membership Officer
..
Applicant
proposed by:
.Seconded:
Elected/Not
Elected Date:
.Signature:
.CHAIRMAN
Certified
that the applicant has been notified of the Committees decision and if a
Member, membership card has been issued.
Details from this application have been entered into the Clubs records
and held on computer for Club purposes only.
Signature:
..Dated
Please send to: Membership Officer, Steve Merry