New Membership and Renewal Form
First Name: *
Your answer
Surname: *
Your answer
New member or renewal? *
Personal details
House Number / Name: *
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Street: *
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Town: *
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County *
Required
Post Code *
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Telephone (Mobile): *
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Telephone (Landline):
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Email Address: *
Your answer
Date of Birth: *
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Place of Birth: *
Your answer
Gender *
Ethnic Group
Do you have a disability?
(‘A physical, sensory, or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities’ (defined by the’ Disability Discrimination Act, 1995’.)
How did you find out about Dursley Running Club? *
Your answer
Date you started coming to the club: *
(If you are unsure of the exact date, the month you started is fine.)
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Interests:
Please select your interest(s) from list below. *
Required
Sharing Details with Club members:
We produce a list of club members with members’ names, addresses, telephone numbers and e-mails which is available to all club members for their reference.
If you are happy to share your details, please tick the relevant box(es):
Subscription:
Subscription is normally £35 for the year for first Claim members and £25 for second claim members. The membership period runs from January to December.

New members joining after 1st July, pay £22 (to cover EA affiliation plus ongoing club costs) and renew with other members on January the following year.

AWAY Members: pay £17 for year, for members living away from the Dursley area but keeping DRC as their first claim club, (covers EA affiliation so they can compete as a DRC member, but not eligible for other membership benefits). Away membership permitted at committee’s discretion.

You can pay by bank transfer (preferred), cash or cheque (payable to “Dursley Running Club”).

Bank: Lloyds,
Sort code: 30 98 29,
Account No: 02213663.
Use Ref: Subs-Initial-Surname e.g. SUBS-BSMITH

The subscription includes membership of England Athletics & associate membership of Dursley Rugby Club.
You will be allocated an England Athletics number and they will send you a card through the post. We can’t guarantee when they will do this, but you should receive it within a couple of months from now.

Data Protection Information
Dursley Running Club will gather, store, process and secure your personal data in line with the requirements of the General Data Protection Regulation (GDPR) 2018.

When you become a member of or renew your membership with Dursley Running Club 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.

*
Required
Choose First or Second Claim: *
Note: Only choose Second Claim below if you are also a member of another Running Club. Information on changing first claim club is available from here: http://www.englandathletics.org/athletics-clubs/club-affiliation#Changing-clubs
If you have chosen Second Claim, please enter your First Claim Club Name:
Your answer
I will pay my subscription (£35) by: *
Would you like to receive club emails with information about events and news? (If you choose "yes" you can opt out again in future). *
Dursley Running Club membership waiver
I understand that I should not enter and run in club events unless I am medically able and properly trained. I agree to abide by the decision of any club officer relative to my ability to safely complete the run. I assume all risks associated with running including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, ice, the conditions of the road and of traffic, all such risks being known and appreciated by me.
Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and for anyone entitled to act on my behalf, waive and release the Dursley Running Club and all from all claims and liabilities of any kind arising out of my participation in these club activities even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Declaration:
I am over 16 years of age and wish to become a member of Dursley Running Club. I declare that I am an “Amateur” as defined by the Amateur Athletics Association and I agree to abide by the rules of the club.

I am willing to contribute to the club events when required.

Signature: *
By typing your name in here, you agree to the Waiver and Declaration above.
Your answer
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