Halterworth Harriers

APPLICATION FOR MEMBERSHIP


Surname: Forename(s):

Address:
Postcode:

Email:
Phone: Home: Work: Mobile:

Place of birth: Date of birth:

Which other athletics club are you a member?

I declare that the above particulars are correct and that I am an amateur as defined by the
UK Athletics and will, if elected, abide by the rules of the Club and the stewardship of its
elected Committee. I agree that my details may be kept in the Club's and UKA's computer records.

Signature: Date:

NOTE – Your annual subscription (£15) must be submitted with this application.

 

FOR APPLICANTS UNDER 17 YEARS:

I consent to my daughter/son becoming a member of Halterworth Harriers. I shall ensure that
she/he will abide by the Club rules.

Signature of parent or guardian: Date:


Date of election to the Club: Signature of Hon. Secretary: