Membership Form

Membership Application Form

Family membership £97.40:- 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 £35.90:- complete the form below with the athlete's details - please provide your own email and mobile number, not the athlete's.

Adult membership £61.50:- complete the form below.

* Indicates required field

Title *

First name *

Surname *

Date of Birth *

Gender *

Male Female

Mobile Number (parent's if U18 athlete) *

Email - this is essential, please check your response carefully *

Address (house no., street name and postcode please) *

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 *

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

Fitness Social reasons Competing

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

EA Registration *

Concessions - please tick the box if any of the following apply *

Under 20 Unemployed Student

Please read the club's policy on data protection (on our website) and select yes to give consent to the club to store your details. 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 *

U18s Parent Handover Agreement - Please choose one option *

I agree to hand over my child to a coach before each session and collect them personally afterwards I am happy to allow my child to attend club by him/herself I am over 18

Please choose how often you'd like to receive your weekly subs request *

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 below, an invoice will be sent out (may take up to 48 hours - please check your spam folder if it hasn't appeared by then). Payment by credit/debit card is preferred. If you are unable to pay using these methods, please contact [email protected] and we will try to assist with alternative methods of payment.

Would you like your payment invoice to be sent by: *

Text (easiest, and best if your spam filter is strict) Email (check your spam folder if not received in 48 hours)

Apple or Google Pay is the easiest option

Membership Application Form

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