Membership

Email *

Password*

Retype Password *

First Name *

Last Name *

Address *

Address2

Town *

Post Code *

Phone *

Date of Birth *

Under 18 *

Yes

Parent / Guardian *

Emergency Tel *

Gender *

Male

Female

Medical Conditions *

Heart Disease

Epilepsy

Asthma

Diabetes

Any allergic reactions

None

Medical Details *

From time to time we may want to use your name and/or photograph on the club website, club newsletter, local newspapers or club promotional material. Please choose 'Yes' below if you agree for us to use the above information and 'No' if you do not want to be included in any publications.

Confirm *

Yes

No

Price

£

Payment Fee

£

Gross Amount

£

Payment Method

Credit / Debit Card

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Privacy Policy

By signing below you are agreeing to comply with the rules of the club, UK Athletics and Welsh Athletics (where appropriate) and participate in activities entirely at your own risk.

Under 16 years Membership

Declaration

Payment Information