Membership Form

Year: 2017-2018

Please complete this form and return it to: Rachel Berryman, Membership Secretary at or Flat 2 Burberry House, London Road, Hook, RG27 9JY.

Annual membership of £25 is payable on 1st April each year. Membership is for the period of 1st April 2017 until 31st March 2018. Payment can be made by

-  Bank transfer - Sort code: 30-91-97 Account Number: 44519460, please put your name as the reference.

-  Cheque – made payable to ‘Hook Runners’, please write your name or the names of the people you are paying for on the back of the cheque.

-  Cash - to be paid to a member of the committee.

PERSONAL DETAILS

Title (Mr, Mrs, Ms, Miss, Dr): ______

Name (in Full): ______

Address:______

______Postcode: ______

Telephone number (Home):______Mobile: ______

Email address:______

Date of birth (DD/MM/YYYY): ______Gender: Male / Female

Emergency Contact (Full name and number): ______

______

CLUB DETAILS

Do you belong to any other affiliated club(s)? Yes / No

If yes, which club? ______

Which club has ‘First Claim’:______

MEDICAL DETAILS

Do you have any medical conditions which could affect your ability to run with Hook Runners? If so, what are they? Have you sought advice from your GP?

______

The club is run by volunteers and it would help greatly if every member volunteered at some time during the club year. Would you be willing to volunteer? Yes / No

Please note all photos uploaded on our Facebook page may be used for marketing.

My name, address, telephone number and e-mail will be included on the Hook Runners address list and I understand that this information will only be used for club purposes. It will not be shared with any third parties with the exception of Association of Running Clubs (ARC) for registration purposes.

For new members:
How did you first hear about Hook Runners? ______

______

Please tell us what goals you are hoping to achieve through your running with Hook Runners: ______

______

I hereby declare that I wish to apply for membership of HOOK RUNNERS and agree to abide by its Constitution and Club Rules and the UKA/ARC rules for competition.

I understand that I undertake all physical activities at my own personal risk and that HOOK RUNNERS does not accept responsibility for any loss or injury incurred throughout my participation in the activities of the club.

Name: ______Signature of Applicant: ______

Date: ______