Macclesfield Harriers & A.C. Couch to 5K (C25K) - Course 7 Application Form
This form can be used to apply for a place on the next 'Couch to 5k' course (Course 7). The course is a 9 week course suitable for those with no running experience at all, who are age 18 and above.

Venue: Macclesfield Athletics Track behind the Leisure Centre, Priory Lane, Macclesfield SK10 4AF
Day/Time: Every Thursday evening from 7.00pm-8.00pm starting on Thursday 7th September 2017.

Each weekly session will last approximately 1 hour and participants are also expected to do 2 x homework sessions between track sessions each week.

Fee: £40 to include all track fees, course material and annual non-competing membership of Macclesfield Harriers until 31st March 2018

Contact: Jenny Airey on c25kcourse7@gmail.com

Email address
First Name
Your answer
Surname
Your answer
Address 1
Your answer
Address 2
Your answer
Town
Your answer
County
Your answer
Postcode
Your answer
Home Telephone Number
Your answer
Mobile Telephone Number
Your answer
Gender
Date of Birth (NOTE: in month/day/year format)
MM
/
DD
/
YYYY
What running experience have you got?
Required
List any disabilities we need to be aware of (or put N/A)
Your answer
List any medical conditions we need to be aware of (or put N/A)
Your answer
Payment Methods (£40)
The fee for the course is £40.

Pay by BACS: Sort Code: 16-24-32 Account: 11038454 Account Name: Macclesfield Harriers & A.C.
Please put your name and post-code as the reference when you make the payment

Or pay by Cheque: Post your cheque (payable to Macclesfield Harriers & A.C.) to the Club Treasurer.

Neil Gunn, Club Treasurer, 15 Beech Hall Drive, Macclesfield, Cheshire SK10 2EF

Payment Method
Declaration (must be completed)
Unless you are a senior non-competing member, volunteer or social member it is a requirement of membership that you compete for the club in races/competitions when asked to do so.

- I confirm that I am eligible to compete under UK Athletics Rules
- I accept that my personal data will be held electronically by Macclesfield Harriers & A.C.
- As a competing member (see above) I agree to my personal data being passed to England Athletics for registration
- Photographs/Videos may be taken of the person named on this form when competing or training (please contact the club welfare officer if this is a problem).

Signature of athlete
Your answer
Welcome to the club ...what happens next.....
After your form is submitted to us then we will wait for the payment to arrive (either by BACS or Cheque) and then we will process your course application request and will send a confirmation and additional information.

We hope you enjoy the course & being a member of Macclesfield Harriers & A.C.

If you have any questions please contact the course leader, Jenny Airey, on c25kcourse7@gmail.com

Macclesfield Harriers & A.C.
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