SOUTH LONDON HARRIERS MEMBERSHIP APPLICATION FORM 2018-2019

Club Headquarters: 194a Brighton Road, Coulsdon, Surrey CR5 2NF www.southlondonharriers.org

PERSONAL DETAILS

Title First name(s) Surname Address

Postcode Tel (home) * Male / Female Tel (mob) * Date Of Birth E-mail * Birthplace (Town & County) *Of parent/ guardian if applicant under 16 years EMERGENCY CONTACT / MEDICAL CONDITIONS

Name Relation to applicant Tel Please give details of any medical conditions, medication, allergies etc

TRAINING & COMPETING

Where will you be training? Crystal Palace Y / N Coulsdon Y / N What are your main interests? Cross Country Y / N Road Y / N Track & Field Y / N Triathlon Y / N Preferred events / distances? Name of your coach? OTHER ATHLETIC CLUBS

If you are joining as a first-claim member having previously been a member of another club, please give: Name of previous club Resignation Date If you are joining as a second-claim member, what is your first-claim club? If elected I agree to abide by the rules and Codes of Conduct of the Club; to wear club kit whenever I represent the Club, and to pay all subscriptions due by me until such time as I resign my membership in writing Signature of Applicant Date For Applicants under 16 years old; The applicant has my permission to join South London Harriers and take part in the Club's activities Signature of parent or guardian Relationship Application together with cheque payable to "South London Harriers" to be sent to:- The Membership Secretary, South London Harriers, 13 Woodmansterne Rd, Coulsdon, Surrey CR5 2DG SLH Subs for year commencing 1 Oct 2018 (Subs for members joining after 30th June 2019 will carry over to 30th Sept 2020) £55.00 Seniors * £25.00 U11 £40.00 U20 / Student / Unemployed * £15.00 Non Active / Social * - Includes England Athletics affiliation fee for 2019-20 year of £15 ENGLAND ATHLETICS (EA) & General Data Protection Regulations (GDPR) When you become a member of SLH you can also choose to register as a member of EA (you will have to do this if you ever compete for the club under UKA rules). SLH will forward your fee to EA on your behalf. Under the new GDPR we are required to inform you that in order to manage your membership, we need to record personal data. We will not distribute or divulge this information to any party or organisation outside of South London Harriers, other than the minimum details required by EA, which they will use to enable access to an online portal for you (called MyAthletics). EA will contact you to invite you to sign in and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with EA, please contact [email protected]. If you do NOT require EA registration, please reduce the included payment by £15 (categories marked * only). EA affiliation is not required for athletes under 11.

Please tick this box to give your permission to store and process your data for the above purposes. (NB - if you do not give permission we cannot register you with EA) SLH Membership No Date Elected UKA No Fee encl.