Membership Form
Title *
Gender *
First Name *
Your answer
Last Name *
Your answer
Date of Birth (DD/MM/YYYY) *
Your answer
Nationality *
Your answer
Address *
Your answer
Postcode *
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
Email Address *
Your answer
Confirm Email Address *
Your answer
Medical Information e.g. Asthma, allergies. Add N/A for none. *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Where did you hear about HERC Triathlon
Your answer
If you were referred by a member please state who
Your answer
I understand that I undertake all physical activities at my own personal risk and that HERC Triathlon does not accept responsibility for any loss or injury incurred throughout my participation in the activities of the club. *
I hereby declare that I wish to apply for membership of HERC Triathlon and agree to abide by its Constitution and Club Rules *
Amateur Swimming Association (ASA) Membership Number
Your answer
I would prefer that my name and / or photos are not published on the website or Facebook page. We will endeavour to meet your wishes but cannot guarantee this.
Payment Instructions
Fees will be paid: Monthly with a one off yearly payment,
NB: If the member leaves and returns in the same year they will be classed as a new member and be charged the annual fee as well as the monthly fee.

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Annual Membership fee
A single payment needs to be made by BACS transfer from your bank to the below account for *£24.50 (see below comment regarding ASA membership). This covers the annual fee (£15.00) and the first month of membership payment (£9.50)

*Please note if you are already an ASA member, ASA membership costs will be deducted and the amount payable will be £16.00.
For the payment reference, please use “Your name/HERC Annual”

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Monthly Membership fee
A standing order needs to be set up with your bank to the below account for a monthly payment of £9.50. This should be set up for the 1st of the month, starting the following month.

For the Standing Order reference, please use “Your name/HERC Monthly”

Please note for both payments the reference is important as it identifies where the payment has come from.

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All payments are to be made to the below bank account:

Account name: HERC Triathlon

Bank details: NatWest (Fareham Branch)

Account number: 51913917

Account sort code: 52-41-32

Data Protection

HERC Triathlon will use your personal information for club administration purposes only. With your email address, we will send occasional emails to keep you informed of club activities. All personal information will be handled in line with GDPR 2018
Affliation
HERC Triathlon is affiliated with Triathlon England, Cycling Time Trials and HOWL Multisport
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