Senior Membership Form
Senior Membership Form
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Email *
(A) First name *
Surname *
Address Name or Number *
Street Name *
Town *
County *
Post Code *
Contact Number *
Date of Birth *
MM
/
DD
/
YYYY
Club T-shirt Size *
(B) Emergency Contact Details - 1st name *
Emergency Contact Details - Surname *
Emergency Contact Number *
It may be essential at some time for authorised persons, acting on behalf of the club, to have the necessary authority to obtain urgent medical treatment for a club member whilst at representative club competition or training. Please  below to give your consent to emergency treatment being given to the named athlete on this form by trained personnel. *
Required
(C) Additional Support - Please detail any disability you have or any additional support you may require from club coaches. *
If there is no information please write ‘NONE’
(D) Medical Information - Please detail below any important medical information that our Coaches / Coach Coordinator should be aware of (e.g. Epilepsy, asthma, diabetes, allergies etc.) PLEASE DO NOT LEAVE BLANK. *
If there is no information please write ‘NONE’
I consent to my special category personal data provided in section A - D to be shared with coaches for the delivery of my safe participation in club activity. This data will not be shared or processed for any other purpose *
Required
CLUB PRIVACY STATEMENT & COMMUNICATION Tavistock AC take the protection of the data we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained and retained in accordance with current and future UK data protection legislation. Please read the full privacy notice carefully to see how the club will treat the personal information that you provide to us. We will take reasonable care to keep your information secure and to prevent any unauthorised access. http://www.tavistockathletics.co.uk/ *
Required
What is your average 5K time, gives us an idea of which group to start you of in? *
Membership Fees - 1st January - 31st December. See notes on membership page about prorate fees. *
“When you become a member of or renew your membership with Tavistock AC 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 my Athletics). 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
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