STEYNING ATHLETIC CLUB ADULT/FAMILY MEMBERSHIP FORM Please complete all sections in CAPITALS. For a Junior Athlete who is not part of a family group please use the Stormers (Juniors) Membership Form obtainable from a Stormers Coach, the Club House or on-line at www. steyningac. co. uk SECTION 1: MEMBERS DETAILS Date of Birth DD/MM/YY NAME If you are a member of another athletic/triathlon club please give details: UKA registration required ADULT 1 yes/no ADULT 2 yes/no Junior 1 yes/no Junior 2 yes/no SECTION 2: CONTACT DETAILS Home Telephone ADDRESS Post Code E-mail Address (use lower case if appropriate) ADULT 1 ADULT 2 Using the appropriate number from list below, please indicate which section of the club is of most interest to those named above. ADULT 1 Junior 1 1 Stormers 3 Triathlon 5 Open Water Swimming 2 Running 4 Swimming 6 Race Walking ADULT 2 Junior 2 By completing this form I will abide by the club rules and will compete in competitions and help at events whenever possible. SIGNATURE ADULT 1 DATE SIGNATURE ADULT 2 DATE To be completed by a Parent/Carer for all Family memberships: By returning this completed form, I agree to my son/daughter/children in my care taking part in the activities of the Club. I understand that in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. I agree to abide by Steyning Athletic Club’s Code of Conduct for Parents/Carers. Signature of parent/carer Continued over page This is a two page application both of which must be completed Date
Membership Fees 2015 / 2016 Existing Members Senior (18 years and over) Student (18 years & over in full-time education) Family (max 2 adults + 2 juniors) Stormers ( 7 years to 17 years inclusive) Social 32. 00 22. 50 64. 00 5. 00 1. 00 42. 00 32. 50 84. 00 5. 00 1. 00 Joining in October to January Senior (18 years and over) Joining in February to May Joining in June to September Student ( 18 years & over in full-time education) Family (max 2 adults + 2 juniors) Stormers ( 7 years to 17 years inclusive) Social 42. 00 30. 00 20. 00 32. 50 84. 00 5. 00 1. 00 Renewing before 30 th November Renewing on 1 st December or later New Members UKAthletics Registration: Please indicate on the previous page if UKA registration is required and add £ 13. 00 to the amount paid for each member requiring registration. Total Amount to Pay (£) Payment Method Payment Enclosed Cheque Cash Yes No Pay. Pal (Please put a X in one box. ) Name on Cheque/Pay. Pal Cash or cheques made payable to Steyning Athletic Club should be given or sent to the Membership Secretary Barbara Ford-Dunn 22 Laines Road Steyning West Sussex BN 44 3 LL Proposed by Signature (Please print name) Seconded by Signature / / (Hon. Secretary Signature)
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