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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