You must have JavaScript enabled to use this form (see your browser preferences). You can carry on, but you will have to write the amounts and the total in the space. Please provide the details of 2nd and subsequent family members, if any, on the bottom of the paper in the same format.

Membership Application and Renewal Form

Year to 31 March 2012

Please enter details in the boxes then print out (there's a button at the bottom), sign & date the form and send by post with cheque payable to Hardley Runners.

Application Details

Runners aged 21 and over (£10) Number: Amount: £
Runners aged 15 to 20 (free) Number: Amount: £
Out of County (£4) Number: Amount: £
Members needing EA registration (£5 extra per member) Number: Amount: £
Social members (£4 per couple or single member) Number: Amount: £
Note: spouses/partners of running members do not have to join separately as social members.
Total amount enclosed (cheques payable to Hardley Runners) £

Member Details

Fill in the details below and use the button to add extra members. If you add too many, just leave them blank.

No. Surname Forename Male / Female EA? If EA member last year enter number Date of Birth DD/MM/YY If member of another EA club insert name Is other club first claim?

Home address – only one per family please:

Print form ready to sign and send:

Declaration

This will appear on the form, which you should print, sign and send off:

I/We undertake to participate in all Club events at my/own risk and will not hold the club or its officers responsible for any loss, damage, injury or any other matters which might arise. The responsibility for members between 15 and 18 years of age remains solely with their parents/guardians or their representative/s who must be nominated in writing. This applies to training sessions, races and social activities.

The data on this form will be stored on computer and will only be passed to UKA bodies for official purposes.

PLEASE NOTE: Club membership cards will only be issued on receipt of a completed membership form and a stamped addressed envelope. Your card will entitle you to a discount at most running equipment shops.

Signed

Note all members to sign please

Date .....................................

Please return with a STAMPED ADDRESSED ENVELOPE to: David McElhenny, 130A Rollestone Road, Holbury, Southampton, SO45 2HA
Tel: 02380 898050