Cheltenham & County Harriers Membership Application 2019/20
Application for Club Membership
Is this a Renewal or New Membership Application? *
Details of Applicant
Details of the person applying for membership
First Name *
Your answer
Surname/ Second name *
Your answer
Gender *
Date of Birth
Please use format: dd/mm/yyyy
Date of Birth *
Your answer
England Athletics (EA) number
If you already have an EA number, please complete this below:
EA Number
Your answer
Applicant Contact Details
Address including Post Code *
Your answer
e - mail address
Your answer
Preferred contact phone number *
Your answer
Membership Type
For all Membership Types other than U11, Associate and Second-Claim, there are two levels of Membership and cost. If you wish to compete for the Club in track & field/ cross-country or road, you will need an EA number. FULL Membership includes a fee payable to England Athletics for this number. You may choose to be a Training Only Member, which does not therefore include the fee to England Athletics, and you will NOT be able to compete for the Club.
Membership Type Required: please read options carefully and select one *
Second Claim Athletes Only - please confirm name of your First Claim Club
Your answer
Emergency Contact Details
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Medical Information
Please include details of any medical information, e.g. allergies, medication, asthma
Medical Information (if none please state n/a) *
Your answer
Event Preferences
Events: Please indicate your main areas of interest *
Required
Volunteering
The Club is run by a dedicated group of volunteers. Without volunteers, the Club could not exist. Please indicate any areas where you can offer support
In which areas can you offer support?
Confirmation of Application
Please confirm that you are submitting this application for Membership and that you have read and accept the C&CH Membership Terms & Conditions. For applicants under 16 this confirmation must be by a parent / guardian
Name of applicant (or parent/ guardian) *
Your answer
Terms & Conditions / Data Protection Policy
To view a copy of the terms and conditions, please contact a member of the Executive committee.

Data protection policy. When you become a member of or renew your membership with Cheltenham and County Harriers you can also choose to be registered as a member of England Athletics (EA) -you will have to register with EA if you ever compete for the club. If you tick the box below we will provide EA with your personal data which they will use to enable access to an online portal for you (called myATHLETICS). 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 EA, please contact dataprotection@englandathletics.org.
If you do not tick the box below and then decide to compete for the club, we will need to register you with EA and we will inform you at the time.

I confirm that C&CH can share my personal data with England Athletics for the purposes stated above *
Payment Information
Payment can be made in one of three ways.
Online payment is preferred if possible - details of Account listed below
Cheques can be posted to: C&CH Membership Secretary, 20b Winchester Way, Cheltenham, Glos. GL51 3HA; or handed to your Coach; or front desk on a training night;
Payment in Cash can also be handed in to your Coach or the front desk in a clearly marked envelope.
Indicate payment method *
Required
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