Stella Athletic Club
2018 Membership Renewal / Application Form
Email address *
First Name(s) *
Your answer
Surname *
Your answer
ID Number *
Your answer
Gender *
ASA License Number
ASA License Number from previous year if applicable
Your answer
ASA Age Group Category *
Actvity *
Required
Residential Address *
Your answer
Postal Address
Your answer
Home Telephone Number
Your answer
Work Telephone Number
Your answer
Cellphone Number *
Your answer
Occupation
Your answer
Company Name
Your answer
Club Actvities
Please indicate the club activities where you will be willing to assist (optional)
Declaration
I hereby apply to become/remain a member of Stella Sports Club, Athletic Section (the Club), and agree to abide by the rules and Constitution of the Club and to notify the Club Secretary if any of the above details change during the period of my membership. I bind myself to, and will adhere to, all decisions made by the Stella Athletic & Sports Club Committees.

I acknowledge that participation in all runs are undertaken entirely at my own risk. I absolve the Club against any claims that may arise directly or indirectly as a result of my participation in such events and hereby agree to indemnify the Club in full against any claims which may be made against it arising there from.

A copy of your responses will be emailed to the address you provided.
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