Additional family member

Additional family member for family membership subscription

* Indicates required field

First name *

Surname *

Date of Birth *

Gender *

Male Female

Email (if athlete has their own and wishes to be notified of events etc.) *

Why do you want to be a member of the club? *

Fitness Social reasons Competing

If you have any medical condition or disability that the club should be aware of, please give details (or state none) *

Do you use a Beta 2 Agonist Inhaler? *

Consent for Emergency Medical Treatment *

I agree to abide by the Club's code of conduct and always behave in a manner befitting a club member when attending events or representing the club *

Do you wish to be registered with England Athletics (if you wish to compete you must agree to this). Social members who do not wish to compete may choose not to register *

Name of primary Family Membership subscriber *

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Additional family member for family membership subscription

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