Application for Senior Membership 2017/18

Part 1 - Personal Details











Part 2 - 1st/2nd Claim Clubs

Rothwell & District Harriers is:



Part 3 - Resignation from Previous Club/s

Are you currently resigning or have you recently (within last 3 years) left / resigned from a running club



Part 4 - Fees

Fees payable by 1st April each year. See below if joining through the year.




Note £14 OF THIS IS PAID TO ENGLAND ATHLETICS

New Members Pro-Rata (At full rate) Subject to minimum fee of £18: April to June £32, July to September £27, October to December £23, January to March £18.

By ticking this box, I confirm I have read and understood the Rothwell & District Harriers Code of Conduct. To view the Code of Conduct


By ticking this box, I understand that I need to make Welfare Officer/ Run Leaders aware of any medical condition or injury that may affect me when training and that I run at my own risk. (all information will be kept STRICTLY CONFIDENTIAL)


By ticking this box, I consent to the information I have given, being used by Rothwell & District Harriers and shared with England Athletics. I confirm I am eligible to compete under UK Athletics Rules and agree to the Terms and Conditions. To view the Terms and Conditions