Mote Runners Membership Form
Forename *
Your answer
Surname *
Your answer
Address *
Your answer
Postcode *
Your answer
Email *
Your answer
Telephone *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Nationality *
Your answer
Disability
Your answer
Emergency contact name *
Your answer
Emergency Contact telephone number *
Your answer
Do you intend Mote Runners to be your first Claim Club? *
Do you have a current or previous registration with another club? *
If yes; please provide the name of your first claim / previous club
Your answer
Please provide your England Athletics registration number (URN)
Your answer
Club membership type/cost: *
Required
Club declaration
Not registering with England Athletics: You will not be registered with England Athletics, and your details will be held by Mote Runners for Club Administration and communication purposes only.
I declare that: *
Required
Club declaration registering with England Athletic
Registering with England Athletics: When you become a member of or renew your membership with Mote Runners you will automatically be registered as a member of England Athletics. We will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into 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 England Athletics, please contact dataprotection@englandathletics.org.
I declare that:
Signature *
Your answer
Date *
MM
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DD
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YYYY
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