Senior Membership Form

Please fill in the form below to join or renew your membership. 

Membership Details

Title
Forename
Surname
Date of birth (DD/MM/YYYY)
County of birth
Country of birth (if not UK)
Gender
Address Line 1
Address Line 1
Town
County
Postcode
Email
Are you a member of another club?
Who is your first claim club?
Do you need UKA affiliation?

Emergency contact

Name
Relationship
Email
Telephone

 

Important Information:

Please change the status if you do not want to be contacted for other communications by Cirencester Athletics and Triathlon Club

Yes I am happy to receive emails, direct mail and telephone calls from us and UKA athetlics only
No I am not happy to receive emails and telephone calls from us and UKA athletics only

 

   To the best of my knowledge and belief, the information given above is complete and accurate.

   I undertake to keep the Club informed of any changes that may arise in relation to the above information.

   It may be necessary at some time for the coaches of the athlete to have the necessary authority to obtain any urgent
       treatment that may be required. By signing the declaration below, I am giving consent for Cirencester Athletics Club
       to administer medical aid by a first aider or equivalent if needed, any medical or surgical treatment recommended by
       competent medical authorities, where it would be contrary to the athlete’s interest, in the doctor’s medical opinion, for
       any delay to be incurred by seeking my personal consent.

   I hereby grant Cirencester Athletics Club the right to use images resulting from photography at coaching sessions
       and athletics events for all general publicity purposes (club website and local newspapers.

   I agree that my details may be held on a computer and processed on a computer for all purposes connected with my
       membership of the Club, the UKA and any other relevant affiliated bodies.