CAR membership form
Complete this form in addition to paying membership fees to apply for or renew membership.
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
Chapel Allerton Runners take the protection of the data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current and future UK data protection legislation. Please read the full data protection statement provided carefully to see how Chapel Allerton Runners will manage the personal information that you provide to us (read here: https://docs.google.com/document/d/1Z0xcRU22TbCVPAFErek8INqnFCyR4-6eAuUPH6boODs/edit?usp=sharing). By submitting your online application form you consent to the outlined usage of your data to administer the club and your membership claim. Please *TYPE YOUR NAME BELOW* to confirm you have read and understood this information.
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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