Title TitleMrMrsMissMsDr

Full Name

Date of Birth

Gender GenderMaleFemale

Address

Post Code

Telephone

Mobile

Your Email Address

Membership Type Membership TypeCouch to 5k £25New Senior £40New Senior Second Claim £18New Young Adult (18-21) £24

Vest size – Men’s Vest size – Men’sXSSMLXL

Are you, or have you been a First Claim member of another Athletic Club? Are you, or have you been a First Claim member of another Athletic Club?YesNo

Vest size – Women’s Vest size – Women’s6810121416

If yes, please name club and resignation date (if applicable/you may need to complete a transfer).

UKA/England Athletics Number (if known).

Running experience - please indicate your experience e.g. beginner, returning to running, experienced runner etc.

To ensure your inclusion in club activities and events, if you live with an impairment/medical condition which requires specific support from us as a club, please indicate this in the Additional Information box and one of our welfare officers will contact you to discuss any help or support we can give.

Any additional information

Details shared with UK/England Athletics. Details shared with UK/England Athletics. I confirm I agree to my details being shared with UK/England Athletics.

England Athletics Code of Conduct. England Athletics Code of Conduct. I agree to be bound by the UKA Anti-Doping Rules and agree to sign up to the Senior Athletes Code of Conduct - see download link beneath this form.

I hereby declare that I am an amateur I hereby declare that I am an amateur I hereby declare that I am an amateur according to the definition of the UKA.

I have read the club constitution (click here to visit the constitution page) I have read the club constitution (click here to visit the constitution page) I have read the club constitution and agree to abide by Section 9 - Conduct of Members

For your own safety, we request that you always carry with you any medical details and emergency contact details.

Title TitleMrMrsMissMsDr

Full Name

Date of Birth

Gender GenderMaleFemale

Address

Post Code

Telephone

Mobile

Your Email Address

Membership Type Membership TypeCouch to 5k £25New Senior £40New Senior Second Claim £18New Young Adult (18-21) £24

Vest size – Men’s Vest size – Men’sXSSMLXL

Vest size – Women’s Vest size – Women’s6810121416

Are you, or have you been a First Claim member of another Athletic Club? Are you, or have you been a First Claim member of another Athletic Club?YesNo

If yes, please name club and resignation date (if applicable/you may need to complete a transfer).

UKA/England Athletics Number (if known).

Running experience - please indicate your experience e.g. beginner, returning to running, experienced runner etc.

To ensure your inclusion in club activities and events, if you live with an impairment/medical condition which requires specific support from us as a club, please indicate this in the Additional Information box and one of our welfare officers will contact you to discuss any help or support we can give.

Any additional information

Details shared with UK/England Athletics. Details shared with UK/England Athletics. I confirm I agree to my details being shared with UK/England Athletics.

England Athletics Code of Conduct. England Athletics Code of Conduct. I agree to be bound by the UKA Anti-Doping Rules and agree to sign up to the Senior Athletes Code of Conduct - see download link beneath this form.

I hereby declare that I am an amateur I hereby declare that I am an amateur I hereby declare that I am an amateur according to the definition of the UKA.

I have read the club constitution (click here to visit the constitution page) I have read the club constitution (click here to visit the constitution page) I have read the club constitution and agree to abide by Section 9 - Conduct of Members

For your own safety, we request that you always carry with you any medical details and emergency contact details.