Southampton Running Sisters Application Form
Name:
Address:
Post Code:
Telephone (daytime):
Telephone (evenings):
Email (please write clearly):
Emergency Contact – Name:
Emergency Contact – Telephone:
Please tick appropriate boxes below:
What is your running experience?
Complete beginner □ Some experience □
Have you ever belonged to another running club?
□
Are you currently a member of another running club?
□
If so please name it here
Medical information:
Please write down ANY medical condition Southampton Running Sisters should be aware of e.g.
back/knee injuries, high blood pressure, diabetes, asthma
…………………………………………………………………………………………………..
…………………………………………………………………
Your date of birth………..….
Note: Southampton Running Sisters is a club for those over 18 years of age only - we also need this information for age classification in any competitions you participate in
I wish to join Southampton Running Sisters
SIGNED……………………………………… Date……………
Please return the completed form by
post with payment enclosed to:
Tina Dempster, Membership Secretary
15 York Close,
Horton Heath,
Eastleigh
SO50 7PX
annual membership £15
□
annual membership(concessions) £10
□
Fee includes affiliation to UK Athletics.
Note: Membership is due for renewal on
1st January each year
*cheques (payable to Southampton Running Sisters) or Postal Order only – no cash by mail
Please enclose a stamped self addressed envelope for acknowledgment if you have no email.
