Membership form 2020/21
If you’d like to join us and become part of our friendly group whilst improving your fitness it couldn’t be simpler, fill in the form below and our membership officer will be in touch.  You’re also welcome to try our sessions for a few weeks before joining.
The club year runs from 1st April to 31st March. Club membership is £10 per annum, or £26 if you wish to be registered with UK Athletics (UKA).

By completing and emailing the below form your are declaring that these are your true details and you are an amateur as defined by England Athletics. These details are required in order to register you with England Athletics they will not be shared with any other company
Personal details:-
Date of Birth DD/MM/YYYY *
Your answer
First Name *
Your answer
Family name *
Your answer
Gender *
Your answer
Address *
Your answer
Postcode *
Your answer
Ethnicity
Your answer
Nationality
Your answer
Contact details:-
Email Address *
Your answer
Mobile number *
Your answer
Emergency contact details:-
Please supply these details in the case of an emergency.
Emergency contact name *
Your answer
Emergency contact telephone number *
Your answer
Medical conditions i.e Asthma, diabetes or allergies. *
Required
If you have answered Yes to medical conditions please supply details:
Your answer
Annual subs
Full membership includes all club sessions, access to our club social media page and UKA registration which gives you a discount when entering most races. Social membership includes all the same except it does not include the UKA registration.

Our Membership Secretary will be in touch after you submit this form to let you know how to pay.
Membership Option *
Required
If applying to become a full member do you consent to Derwent Runners sharing relevant information with England Athletics Limited? *
Please note we need to have your consent to register you with England athletics according to GDPR rules. We will not be able to register you unless you click Yes below.
I declare that I am an amateur as defined by England Athletics *
Required
Submit
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