Luton Athletic Club
Membership Application Form 2009
Full Name Mr/Mrs/Miss/Ms________________________________________________
Post Code ___________ Telephone no. _______________________
Date of Birth __________ Age on 1st Sept 2009_____________
Nationality _________________________ County of Birth______________________
Email address @ .
Application to renew Membership
I hereby apply for membership of Luton Athletic club and I understand my obligations under UK
Athletics rules. I agree to abide by the Constitution and Rules of the Club. I am fit to take part in
strenuous physical activity and understand that I am expected to compete for Luton AC.
Signed ___________________________________ Date _________________
Membership fees include £5.00 England Athletics (UKA) affiliation fee
University students living away from home get free membership for the duration of their course but must
pay the UKA affiliation fee.
Senior / full membership £42.00
Junior membership £27.00
Student membership £27.00
Family membership ( 2 adults & 2 children ) £77.00
For family membership only add £5.00 UKA affiliation fee per competing athlete
U11 membership £0.00 Membership free until 11th birthday
Social membership £5.00
University student £5.00 UKA affiliation fee £5.00
Amount paid £…… £…….
Club vest-available from Mike Hardy is required for all competition. £15.00
As a member of Luton Athletic Club you will not be able to join any other athletic club as a first
claim member unless you are a paid up member of this club and a resignation, in writing, is
received from you.
Luton Athletic Club is open to, and welcomes all members of the community
Complete this form and return it to;
Mr A Sparshott. 67 Luton Road Dunstable Beds LU5 4LW 01582 471751 or to the membership
post box in the bar in an envelope. Do not give this form to anyone else.
Your details will held on a computer database. Your details will not be passed to anyone other
than club officials. Please make cheques payable to Luton AC
For Club Use
Subscription Received _________________________ Accepted_________________