Application for Membership


Existing members should login and use the add member function to receive the discount

* - Required field

Personal Details

Female Male

Address



Parent/Carer Information (if under 16)

Surname: Forename:
Tel: E-mail:

Emergency Contact Information

Name: * Relationship: * Tel: *
Medical Conditions:
It may be essential at some time for authorised persons acting on behalf on the club to have the necessary authority to obtain urgent treatment which may be required whilst at representative club competition or training. I give my consent to emergency treatment being given to the named athlete by trained personnel: * Print Name: *

Area of Sport and Disciplines

Area of Sport:Discipline choice 1:
Discipline choice 2:Discipline choice 3:
Discipline choice 4:Discipline choice 5:

Volunteering for your club (a condition of your membership)

Role choice 1:* Role choice 2:

Declaration

*
I am not a member of an athletics club affiliated to UK/England Athletics
I am a member of an athletics club affiliated to UK/England Athletics, the club being:
I was a member of an athletics club affiliated to UK/England Athletics, but ceased to be a member of: on the date of:
*

Athlete Code

I am willing to abide by the club code of conduct for athletes and agree to always behave in a manner befitting an athlete: *

Data Protection

I certify that I understand, the data provided on this form will be used solely by Leamington Cycling and Athletics club for purposes of club administration and ensuring safety. Data contained on this form which is required as part of your UK governing body registration will be shared with the relevant body. We will not disclose your data with any other external third party. Your data is stored in line with the clubs data protection policy: *
Please input a Password for future use: *
Acceptance Code(your coach can provide otherwise you can still submit but your application requires approval first):