WALTHAMSTOW ATHLETIC CLUB
Hon. Secretary:D Rose
E-mail form to danrose@btinternet.com
I HEREBY APPLY FOR/RENEW MEMBERSHIP OF THE CLUB
NAME FIRST NAMES ..
ADDRESS ..
Telephone No ..email address ...
DATE OF BIRTH .PLACE OF BIRTH .
SCHOOL/COLLEGE ATTENDED (If applicable)
ARE YOU A MEMBER OF AN ATHLETIC CLUB? YES / NO If yes please state name of club
And whether 1st or 2nd claim:
NAME of CLUB .. First claim/Second claim .
If you have been a member of an athletic club please state name of club and date of resignation.
Previous club ..Date of resignation ..
All applicants for membership must be amateurs as defined by the UK Athletics body.
Medical history: Please state any medical condition that can affect training or competition, e.g. asthma:
..
DECLARATION I declare that I am an amateur as defined above
.
SIGNATURE OF APPLICANT .. DATE
Current rates of subscription (Due date 1st JANUARY) :
SENIORS (OVER 19 YEARS) £20.00 PER ANNUM JUNIORS £12.00 PER ANNUM
Cheque/Cash of £ .enclosed with application.
Office use: Date received Subscription received
Proposed by: Seconded by: .
Approved on ..