Running in the Burbs Initial Membership Registration Form
This form is to apply for first time, Running in the Burbs Membership (Full or Trial) for the financial period of 01/07/17 – 30/06/18.

If you have already registered all of your membership details with us and are currently training with us of June 2017 then, you should close this form and update you details with the "Renew and Update" link on the web site (Full membership assumed only).

(Note, Continuing "Trial "members that may require updates to our register should not use either form but should email their corrections to info@runningintheburbs.org.au)

Membership types
Full 2017/2018 Membership - $50
Trial Membership - $2 per session for a maximum of 10 weeks

First Name
Your answer
Last Name
Your answer
Gender
Date Of Birth
American format.. month first
MM
/
DD
/
YYYY
Member Type
Please note: A trial membership is for 10 weeks at $2 a week.
Email Address
Your answer
Street Address
Your answer
Suburb
Your answer
Postcode
Your answer
Phone Number
Mobile or Home
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Known Allergies
Your answer
Known Health Issues
Your answer
First Aid Qualification(s)
Do you hold a current and recognised qualification in First Aid or CPR? (Please Spec)
Your answer
Fitness Training Qualification
Do you hold a current and recognised qualification in Run Leading or Personal Fitness?
Your answer
Preferred Event Style
Tick up to 4 types of running event
Required
Which specific event is your favourite or you are most keen to try?
Your answer
Waiver
Please note that by completing this form you are agreeing to this waiver. As a condition of acceptance of my membership to Running in the Burbs, Inc (RITB) I hereby waive myself, my heirs, executors and administrators of all and any claims, rights of cause of action which I or they might otherwise have for/or arising out of loss of my life or injury, damages or loss of any description whatsoever, which I might suffer or sustain in the course of/or consequences upon my entry or participation in an RITB event.
Required
Payment Status
Please ensure all payments clearly detail who they are from and what they are for.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms