Membership form 2011-12 by BevHde9

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									                         FOREST OF DEAN ATHLETIC CLUB
                                  Membership Secretary: Kathy Russell               Tel: 07774 152655
                                Email: clubmembership@fodac.org.uk                 www.fodac.org.uk

                                       Membership Form
                                 1st April 2011 – 31st March 2012


TO BE COMPLETED BY ALL MEMBERS
Membership is available on an individual or family basis – please complete one form per member,
indicating which type of membership is required. Membership is renewable on 1st April each year.

                                                                               Membership
 Surname                                                                       Number (existing
                                                                               members only)

 Forenames

 Title                                               Date of Birth



 Address



 Postcode                                            Telephone Number

 Email Address




FOR NEW MEMBERS ONLY: (please circle answer)


 Are you an……             Active Competitor                    Coach                           Official

 Have you completed & returned a Medical Form?                              Yes                       No

 Do you agree to the Club holding your membership details on
                                                                            Yes                       No
 computer?



FOR MEMBERS OF OTHER ATHLETICS CLUBS ONLY

 Name of other Athletic Club:

 Have you resigned from that Club?                                          Yes                       No

 Do you wish to join FODAC as your 1st or 2nd Claim Club?                    1st                      2nd


                                                                                          See over….

                                                                                                    page 1
FOR COMPLETION BY ALL MEMBERS

Please select the membership type that you require. If you are a Senior or Family member who wishes to
compete, the England Athletics fee is payable.

                                                                                                    Amount
 Category                                       England Athletics Fee Status             Fee Due
                                                                                                    Paid

 NuStarz Member - aged U11 on 01/09/11          No England Athletics fee required          £5.00

 Junior Member - aged 11 and under 18 on
                                                England Athletics fee included             £15.00
 01/09/11and students
 Senior Member : aged 18 & over on
                                                England Athletics fee not included         £15.00
 01/09/11
                                                England Athletics fee required for all
 Family Membership:                             competing athletes – see note              £20.00
                                                below
                                                England Athletics fee required for
 Life Membership                                                                           £ free
                                                competing athletes

 England Athletics Fee – due for all
 competing athletes who will be 11 years old    Payable per competing member –
                                                                                           £5.00
 & above during the current year on             see note below.

 01/09/11.

                                                                                           Total    £



Note: England Athletic fees are due for every athlete who will be 11 years old & above during the current year
on 01 September 2011. All competing family members over 11 are required to pay the England Athletics fee.
Coaches and qualified officials are not required to pay the England Athletics fee.



Declaration:
I confirm I have read the Code of Conduct which is on the Club website www.fodac.org.uk
and displayed in the Club Container.



Signed _____________________________________________ Date ______________________________


                           Please make cheques payable to Forest of Dean AC

    Please return your completed form to: Kathy Russell, Oakleigh, Chepstow Road, Sling, Coleford
                                  GL16 8 JE or post in the Club Hut.
                                     Telephone: 07774 152655
                                                                                                    page 2

								
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