Crook & District AC Membership Form

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Crook & District AC Membership Form - Senior Section

Please pay cash/cheque to Club Treasurer Harry Binyon (cheques payable to Crook & District Sports & AC) or preferably by BACS transfer directly into the club bank account:

Crook & District Sports & AC

Account Number: 30581313

Sort Code: 20-09-44

Add your surname and the word membership as the reference

If editing this form after previously filling in to update details, please email enquiries@crookac.co.uk to notify Danny / Captains of amendments. Please also make sure you update your details on the EA portal

Email *

Forename *

Surname *

Contact Number *

Date of Birth *

YYYY

Sex *

Male

Female

Other:

Home Address *

Home Post Code *

Emergency Contact Details - Name *

Emergency Contact Details, Contact number *

Emergency Contact Details, relationship to you *

Ethnic Origin

Please state any medical/special category health condition(s) of which the club should be aware of and which you agree to be shared with club coaches where necessary to allow for the safe running of training sessions

England Athletics Registration Number (if you know it, if not please put N/A)

Do you have any athletics coaching qualifications or experience? If ‘yes’ please provide further details.

ANNUAL SUBSCRIPTIONS (please select required option)

Membership Fees - Also includes Club Vest or T-shirt:

1st April - 30th September £50
1st October - 31st December £35
1st January - 31st March (New unregistered members only) £50, up to and including the following year

First Claim other (Affiliated to another EA Club in alternate disciplines) £35

Second Claim Member (Affiliated to another EA Club) £20

Competing Member with all track fees included for the year £105 - (only beneficial if joining in the first 4 months of the year)

England Athletics affiliated (competing) member

England Athletics affiliated (competing) member and ALL track fees

First Claim Other Member

Second Claim Member

Important – please complete the following disclaimers by ticking each box as appropriate

Club vests must be worn when representing the Club at any official event.

I agree that in the event of injury or illness the club can contact my emergency contact.

I agree to the use of photography for Club material and promotion.

I agree to media being shared on Crook AC Group pages/platforms.

I agree to live tracking of my race progress being shared with other members on Social media platforms.

I agree to receive emails about Club activities and other info relevant to my membership.

I accept that my personal data will be held electronically by the Club.

I agree to the use of my personal details within the Club and only when necessary.

I confirm that I am eligible to compete under UK Athletic Rules.

I agree to all of the above, signed: *

Date: *

YYYY

A copy of your responses will be emailed to the address you provided.

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