Tuesday 2 February 2010

Application Form


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Southampton Running Sisters Application Form

you can download a copy of this form from our web site http://srs.org.uk/members.html



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.