Redway Runners

Membership Application to 31 March 2017

New Application / Renewal / Add UKA to existing * please delete

Member Number (if known insert your member or UKA number): ______

Title / First Name / Surname
Address
Postcode
Telephone Number
E-Mail
Date of Birth
(must be 16 or over)
Male / Female
Emergency contact:
If there is any medical or health information we need to be aware of please complete below,

Do you wish to register with UK Athletics – if yes see part 2 Yes/No ______

Part 2 – Notes for UK Athletics registration

FOR NEW UKA MEMBERS:
Do you want to register Redway Runners as your First Claim UKA Club? / Yes/No
IF ALREADY UKA MEMBER:
Registration Number
First Claim UKA Club
Do you want to register Redway Runners as your Second Claim UKA Club? / Yes/No
Do you want to change your First Claim UKA Club to Redway Runners? / Yes/No

UKA affiliation allows individual entry to UKA affiliated races without having to pay the additional unattached levy. By choosing UKA affiliation you consent to allow the club to provide your details to UKA officials.

For new or renewal of First Claim UK Athletics registration add £13 to your membership fee i.e. £18 in total,cheques payable to ‘Redway Runners’.

Data will be recorded for use within the club only; it will not be shared with any external parties, other than by affiliation with UKA.

I understand I engage in club activities at my own risk.

Medical consent – I am happy for Redway Runners to pass my medical information to the Redway Runners medical advisors who may contact you to discuss further if appropriate.

I wish to join Redway Runners and the information provided is correct to the best of my knowledge and I agree to abide by the club equity statement and runners guidelines, which can be found on the club website. I also take personal responsibility for my running.

Fees
Redway Runners Membership (£5.00)
UKA (£13.00) / £______
£______Total £
Signed: / Date:
Cheques payable to ‘Redway Runners’
Please bring your application to a club run or send to:
Redway Runners
23 Thomas Drive.
Newport Pagnell MK16 8TD
Bank payment (please ensure your name is included in the payment so we can identify it); Sort code 301553 Number 42390360 Name; Redway Runners
Please scan the application and send it to:

and remember to join our Facebook page search ‘Redway Runners’

Join us running Wednesday’s at 9.30 from David Lloyd Reception or Monday evening at 19.00 at the Decathlon store in Rooksley

Redway Runners

Redway Runners

Affiliated with Association of Running Clubs

Affiliated with UK Athletics

Run England Registered Group