get membership form _Excel_ - Marlow Striders

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get membership form _Excel_ - Marlow Striders Powered By Docstoc
					Marlow Striders                                  Membership Application Form
Please circle as appropriate:
New Member              Senior        £40        Family       £55      Junior      £10     Senior Citizen £25
Renewal                 Senior        £35        Family       £50      Junior       £5     Senior Citizen £20
Note: the above fees do not include affiliation to English Athletics (EA)!
If you wish to be affiliated & pay the EA affiliation fee of £5 please put an X in the box:
(Please note Date of Birth is required for EA affiliation.)
Please enter membership details
First Name                                                           Telephone
Last Name                                                            Mobile
Address                                                              E-mail



                                                                     Gender : Male / Female
Date of birth

Please name any other running club you are a member of
                                                                                First claim: Yes / No
If applying for family membership please provide details below:
First Name                          Date of Birth             Male / Female          Add EA Affiliation Fee £5?

                                                              M/F                    Yes/No
                                                              M/F                    Yes/No
                                                              M/F                    Yes/No
I declare that I agree to abide by club rules, am medically fit to run and understand that I join
the club at my own risk and that the club, its committee, coaches and members will under no
circumstances be held responsible for any injuries I may incur.
Signed                                                              Date
Parent's signature if under 18 years
In accordance with the Data Protection Act of 1988, we are obliged to inform you that any information you
provide to Marlow Striders will be kept on a computer database for use only by the club. To this end, by
providing Marlow Striders with any of the above information you give your consent, which can be
withdrawn at any time. Marlow Stiders will only process any data held for legitimate reasons.
Should you require any additional information, or would like your details amended or removed from the
database, please contact the Membership Secretary.



Please either hand or post your completed application form to:

Membership Secretary, Marlow Striders, 18 Badgers Way, Marlow, Buckinghamshire SL7 3QU
Tel: 01628 475548   E-mail marlowstridersmembership@googlemail.com

Payment either by cheque payable to Marlow Striders or electronically to Marlow
Striders Account as per bank details below, including your name as a reference:
Account Number 80600903        Sort Code 20-40-71

				
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