Brixham Harriers Running Club - Membership Application / Renewal Form: 2017-2018
Please state if you have any medical conditions or are on any long term medication, e.g. use an inhaler, suffer from epilepsy / asthma or diabetes etc:
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I declare that the club shall not be liable for accident, injury or damage as a consequence of my membership in Brixham Harriers Running Club. I declare I am medically fit to take part in running.
Any previous club affiliation:
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Date of Resignation:
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Emergency Contact Name:
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Contact Telephone number:
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I declare that I am an amateur runner to be bound by the rules of UK Athletics and also the rules of Brixham Harriers Running Club as contained within the Club Constitution. I accept that my details will be held on a computer database and that this information will only be passed to certain club officials on a need to know basis. All personal information will remain confidential. I agree to wear the club colours / vest if entering an event as a club member.
In signing this form you agree to your photograph and name being used to promote the club in the press and on the club’s website and Social Media – please indicate if you do not agree to this.
All cheques payable to ‘Brixham Harriers’; please return to the Club Secretary or bank transfer to Brixham Harriers Running Club: branch sort code 30-88-04, account 24291360.
Club’s annual membership fee for April 2017 to March 2018 = £15,
Membership reduces for new joiners after Sept 2017 as follows:
Anyone joining 1 Oct – 31 Dec 2017 = £10
Anyone joining 1 Jan – 31 March 2018 = £5.
Optional: England Athletic membership fee for 2017 to 2018 = £14.00 (membership No. ____________ )
Total Fee Paid = £ ______ , date = ___ / ___ / ___
Club Membership Application Form April 2017
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