CAR membership form
Complete this form in addition to paying membership fees to apply for or renew membership.

*Membership is only open to over 18's*

New member or existing member renewal?
First name
Your answer
Surname
Your answer
Address
Your answer
Post code
Your answer
Phone number
Your answer
Date of birth
MM
/
DD
/
YYYY
Email address
Your answer
Country of birth
Your answer
Are you a member of any other running club?
If you are a member of another running club state which club
Your answer
Will CAR be your 1st claim or 2nd claim club?
Do you have any medical issues? (e.g epilepsy, asthma, diabetes, allergies etc). Do not leave blank – if there is no information write ‘None’.
Your answer
Emergency contact name
Your answer
Emergency contact phone number
Your answer
Emergency contact name 2
Your answer
Emergency contact phone number 2
Your answer
Authorised persons acting on behalf of the Club may need to obtain urgent medical treatment whilst at club competition or training. *PLEASE TYPE YOUR NAME BELOW* to give consent to emergency treatment being given to the named athlete on this form by trained personnel.
Your answer
Do you agree to the Club's Terms of Membership and Code of Conduct? (read here https://drive.google.com/open?id=0BxAnWnCEWLooNHExNVRVQlQxUlE) If YES, please *TYPE YOUR NAME BELOW*.
Your answer
Date, method and amount of payment? e.g. BACS, gave cash to committee member etc. If you did not pay the Standard £45 fee please also give the reason e.g. retired, 2nd claim etc.
Your answer
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