Buckley Runners

Application for Club Membership (new member) for the year April 2017 to March 2018

Section A To be completed by all applicants

Title
/ First name/s / Surname
Gender (M/F) / DOB (senior members must be 18 years old)
Address
Post Code
Telephone number / Mobile number
Email address

Section B Registration with Welsh Athletics

How do you wish to be registered with Welsh Athletics? / Competitive?
(Entitles you to run in inter-club competitions and get reduced entry fees for races) / Yes/No / Non-competitive?
(You can change this later if you wish) / Yes/No
Or as second claim? (please complete Section C) / Yes/No
Or are you transferring from another club? / Yes/No
If you have formerly been a member of another athletics club you will need to complete the formal transfer process, using the form available on Buckley Runners or Welsh Athletics website. If you are unsure about this please contact the membership secretary (see contact details below).
We will mark your events at Road running, Fell Running and Cross Country. You can change this (and any other information) once the registration process is complete and you have access to your profile.

Section C. Second claim membership.

Name of first claim club
What is your registration number (WA or other)

Signature

Not required if sent by email / Date
Required

Annual subscription (2017-18) for Buckley Runners is £15 (£10 for 2nd member at the same address and juniors) (required by all applicants)

Registration to Welsh Athletics is £17.50 (Not required for non-competitive or second-claim applications)

Please add £12.00 for a club vest if required.

Application and Payment

By cheque payable to Buckley Running Club posted with this form to Jack Thomas, (Membership Secretary for Buckley Runners), 19 Maplewood Grove, Saughall, Chester. CH1 6AD

By email/BACS Email this form to Jack Thomas ( ) and send your payment to account number 11161083, (Buckley Running Club) at HSBC in Holywell, Sort Code: 40 24 27 quoting your name as the reference.

Data Protection. UK Athletics, Welsh Athletics and Buckley Runners may use your personal data for the purpose of administering your involvement in athletics, and to send you information by post, e-mail or SMS related to those purposes. The Athletics Governing Bodies may share your personal data with each other and other organisations involved in the administration of athletics in carrying out these purposes.