Black Pear Joggers 2018/19 Membership Form
Please check all details carefully before submitting.
Once you have filled in the membership form you will receive an email from UK athletics to request payment. This is sent once the membership secretary has processed your membership form, so may take a week or so (you can still run with the club in the meantime). Please follow the link in the email to pay your membership.
* Required
1) Personal details
First we need some of your details for our records.
Title
*
Choose
Mrs
Mr
Miss
Ms
Dr
Prof
Reverend
First name
*
Your answer
Last name
*
Your answer
Gender
*
Male
Female
Date of Birth
*
Enter in the format: dd/mm/yyyy, e.g. 31/12/1970. You must be at least 18 to run with the club.
Your answer
Do you have any health conditions or learning/physical disabilities?
Your answer
How did you hear about the club?
Your answer
2) Contact details
Please enter your current address, phone and email address. We will not pass your details on to any third parties.
Address line 1
*
Your answer
Address line 2
Your answer
Address line 3
Your answer
Town/City
*
Your answer
County
*
Your answer
Postcode
*
Your answer
Telephone number
*
Either a landline or mobile, whatever is best should we need to contact you
Your answer
Email address
*
Please double-check the spelling of the address
Your answer
3) Affiliation details
If you have previously affiliated with another club, we need to know as we need to follow certain procedures with UK Athletics.
Have you previously registered with another club?
*
Yes
No
If so, what is the name of the club?
Your answer
4) Emergency contact
Please enter details of someone that we can contact in the event of an emergency.
Emergency contact name
Your answer
Emergency contact number
Your answer
5) Notes for all members
The ethos of our club is that no-one is left behind on club runs. If someone in the group is struggling you are expected to muster from the front to the back – please don’t just wait for them to catch up as it can be demoralising.
Your group leader is a volunteer who has agreed to set the pace and distance for the run and requires your support to ensure the safety of the group. Please be guided by your leader. Failure to do so could result in your membership being cancelled.
Remember to think about safety, not just when crossing roads but also when running over uneven land, in dusk or in the dark conditions. Wearing fluorescent/high visibility clothing is recommended. In the event of someone becoming injured a minimum of 2 people must stay with the injured member until help arrives.
If you are new to exercise or have not exercised for some time you are recommended to visit your doctor before running with the club. Please read the club’s Health & Safety policy and Risk Assessments on the website for further guidance:
www.blackpearjoggers.org.uk
6) Terms and conditions
By completing and submitting this form I understand and accept that:
* I am declaring that I am an amateur as defined by the eligibility rule of UK Athletics.
* I am 18 or older.
* I take part in the club’s activities entirely at my own risk and that I will be responsible for my own safety whilst out running with the club or when I take part in events as a club member.
* All personal information will be stored securely and will not be passed on to any other party apart from England Athletics who will need some information about you so that we can register you as a member of this club.
* I have read the Health & Safety policy and Risk Assessments on the Black Pear Joggers website.
Tick the following box if you agree
*
I accept the terms and conditions
Required
7) Application type
Membership runs from April to March. However, new members who join the club part way through the year will only pay a reduced amount according to the month in which you first join.
Standard membership: This includes UK Athletics affiliation fee of £15, which entitles you to many benefits including reduced race entry fees, London marathon ballot places, eligibility to run in cross country leagues and discounts from many sports shops.
Basic membership: If you do not want the benefits of UK Athletics affiliation or are joining as a second claim member, you can pay the basic membership fee to the club.
Application type
*
Standard affiliated membership (£25/yr)
Basic membership / second claim (£15/yr)
Notes
If you have anything else you would like to mention, please enter it below
Your answer
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