Redway Runners

REDWAY RUNNERS Membership Application to 31 March 2018 New Application / Renewal / Add UKA to existing * please delete Member Number (if known insert your member or UKA number): ______Title First Name Surname

Address

Postcode Telephone Number

E-Mail

Date of Birth (must be 16 or over) Male / Female Emergency contact:

If there is any medical or health information we need to be aware of please complete below,

Do you wish to register with UK Athletics – if yes see part 2 Yes/No ______Part 2 – Notes for UK Athletics registration FOR NEW UKA MEMBERS: Do you want to register Redway Runners as Yes/No your First Claim UKA Club? IF ALREADY UKA MEMBER : Registration Number First Claim UKA Club

Do you want to register Redway Runners as Yes/No your Second Claim UKA Club? Do you want to change your First Claim UKA Yes/No Club to Redway Runners?

UKA affiliation allows individual entry to UKA affiliated races without having to pay the additional unattached levy. By choosing UKA affiliation you consent to allow the club to provide your details to UKA officials.

For new or renewal of First Claim UK Athletics registration add £14 to your membership fee i.e. £19 in total.

Data will be recorded for use within the club only; it will not be shared with any external parties, other than by affiliation with UKA.

0d6eca7b7d8d18ff240fe4ed6dd0 26/04/2018 15:31 a6f2.doc I understand I engage in club activities at my own risk.

Medical consent – I am happy for Redway Runners to pass my medical information to the Redway Runners medical advisors who may contact you to discuss further if appropriate.

I wish to join Redway Runners and the information provided is correct to the best of my knowledge and I agree to abide by the club equity statement and runners guidelines, which can be found on the club website. I also take personal responsibility for my running.

Fees Redway Runners Membership (£5.00) £______UKA (£14.00) £______Total £ Pay by (please delete); Bank Payment / Cheque / Cash (would prefer Bank or cheque)

Signed: Date:

Cheques payable to ‘Redway Runners’ Please bring your application to a club run or send to: Redway Runners 23 Thomas Drive. Newport Pagnell MK16 8TD

Bank payment (please ensure your name is included in the payment so we can identify it); Sort code 301553 Number 42390360 Name; Redway Runners Please scan the application and send it to: [email protected]

www. RedwayRunners.com and remember to join our Facebook page search ‘Redway Runners’

Join us running Wednesday’s at 9.30 from David Lloyd Reception or Monday evening at 19.00 at the Decathlon store in Rooksley

Redway Runners is an affiliated club with: Association of Running Clubs (ARC), UK Athletics (UKA), Triathlon England, South of England Athletic Association (SEAA), Bucks Athletics Association and Sport MK

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