Membership Form Hannah

Membership Application Form

NB Please complete the checkout process at the end of this form, even if you plan to pay by cheque at the club - you will be given the option to choose these methods of payments at checkout.

Family membership £95 (current price £45):- please add any additional members of your family by completing this form - please click on the link for each person you wish to add, you will return to this page once form is submitted. Finally, complete the form below with your own details.

Junior membership £35 (current price £20):- complete the form below with the athlete's details - you will need to give your own email, phone number and address at checkout.

Adult membership £60 (current price £25):- complete the form below then supply the requested details at checkout (email, phone number and address).

* Indicates required field

First name *

Surname *

Date of Birth *

Gender *

Male Female

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)

Medical Info *

Do you use a Beta 2 Agonist Inhaler? *

Consent for Emergency Medical Treatment - There may be occasions where an athlete needs to be treated immediately, particularly in life threatening situations. We need to know that you are happy for emergency medical treatment to be carried out if necessary.

Consent for treatment *

Emergency Contact Name and Tel No. *

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

Code of conduct *

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

EA Registration *

Please read the club's policy on data protection (on our website) and select yes to give consent. Your details will also be shared with England Athletics. If you do not consent, we will be unable to process your membership application

Data Protection *

The club may need to contact you by email, text etc. with important club info and notifications. Please indicate your preferred method(s) of contact:-

Choose all that apply *

Email Text FB Messenger

I consent to Birtley AC using images of me (or my child) on their website, FB page and other social media. We will comply with your wishes on our own media should you opt not to allow use, but we may be unable to prevent their image from being published by other organisations.

Photography consent *

Our club is run on a purely voluntary basis. If you can help out, please indicate which task(s) would be willing to assist with.Select all that apply Assisting training Committee post/administration Fund raising Refreshments and social events Team management Supervision of athletes Other (please state)

Please indicate if you can help with:- *

Other *

When you click on the Submit button, you will be taken to the payment page. Payment may be made by credit/debit card, or if you'd prefer to pay by cash or cheque at the club, that is a payment option too. Please complete the checkout procedure - you will NOT be asked to provide any card details if you've chosen to pay by cash or cheque, but we'll need your address and telephone number for our records. Thank you.

Membership Application Form

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