Application for Senior Membership 2018/19

Part 1 - Personal Details











Part 2 - 1st/2nd Claim Clubs

Rothwell Harriers & A.C 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 £15 OF THIS IS PAID TO ENGLAND ATHLETICS

New Members Pro-Rata (At full rate) Subject to minimum fee of £19: March to June £33, July to September £28, October to December £24, January to Feburary £19.

By ticking this box, I confirm I have read and understood the Rothwell Harriers & A.C 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 Harriers & A.C and shared with England Athletics as described in the Data Protection Statement . I confirm I am eligible to compete under UK Athletics Rules.