Handsworth Roadhogs

Membership Application Form

Please complete this application form in BLOCK LETTERS.

Personal Details

Full Name:	Date Of Birth:	Gender:
Address:
Post Code:	Email Address:
Home No:	Mobile No:

*If Applicant is under 18 please provide Telephone contact of Parent/Guardian.

Membership of Other Running Clubs

Are you a member of another running club:YES/NO	If Yes Which One:
First or Second Claim:	Date of Resignation from Previous Club:

Membership Information

Please indicate which category you are applying for:
Over 18 (First Claim):	Over 18 (2^nd Claim or non-competitive):	Junior (Under 18):	Un-Waged:	Associate Member:

All members

[] I confirm that I am eligible to compete under UK Athletics Rules. (Please tick box)

[] I confirm that my personal data as recorded above will be held on record by the club. (Please tick box)

[] I confirm that as a club member I agree to the club's code of conduct (Please tick box)

I wish*/do not wish* my email address to be shared with Handsworth Roadhogs members (*Please delete as required)

First Claim members only

[] I confirm that my personal data as recorded above will be passed onto England Athletics. As part of my registration England Athletics will then create an online portal for me to update my personal data and set my own privacy settings. (Please tick box)

Signed_______________________________________ Date________________________

Parent/Guardian________________________________ (if under 18)

Amount Paid: __________________________________ Cash / Cheque/Bank Transfer (Cheques payable to Handsworth Roadhogs)

For Bank Transfer please use your name as reference and pay to:Sort Code 30-96-26. Account 73178168, Account Name: Handsworth Roadhogs

Subscriptions are payable with this form and then annually between 1st January and 31^st March.

This completed form and appropriate fees should be given or sent to the Membership Secretary:

Andrew Lewis

83 Wingfield Cres

Sheffield

S12 4WA

Or email to - Andrew.lewis1965@gmail.com

Fees are as Follows:

First Claim*	25.00 Pounds	16.00 Pounds of this fee is paid to England Athletics for a competition licence which entitles you to pay reduced affiliated rates in road races.
Second Claim*or Non-competitive	10.00 Pounds
Junior (Under 18) / Un-waged	10.00 Pounds
Associate Member (non-running)	4.00 Pounds

*Note first claim means this will be your main or only running/athletics club membership. Second claim means you are already a member of another club.