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Wreake Runners Kidz Zone

Kidz zone

 Info 4 the young members
 
Running Results
 

Adult Registration Form
2011 - 2012

Stage 1. Your details
Stage 1 of 2
Your details         Payment

Membership is open to all groups of the community.
   
Member 1  
Name
Date of birth
Date you joined the club
Email
1st or 2nd Claim Club
Member 2*  
Name
Date of birth
Date you joined the club
Email
1st or 2nd Claim Club
 
Member 3*  
Name
Date of birth
Date you joined the club
Email
1st or 2nd Claim Club
Member 4*  
Name
Date of birth
Date you joined the club
Email
1st or 2nd Claim Club
 
*Additional Adult membership
 
Address
Postcode
Tel (Home)
Tel (Mobile)
 
Annual membership / registration fees Cost
Each Adult Runner
£5.00 of this is for Affiliation Fees England Athletics 		£20
Each additional Adult Runner (sharing newsletter)
£5.00 of this is for Affiliation Fees England Athletics		 £18*
Each 2nd Claim Runner
(assuming affiliated to EA with 1st Claim Club)		 £15
Each Associate (Non Runner) Member £10
 
Your personal bests
Please take the time to complete if applicable. These will be used for PB listings
 
          Best in your present veteran age group**
Name 10k 10Miles 1/2 Mara Full Mara 10K 10Miles 1/2 Mara Full Mara
** Vet Groups 40-49, 50-59, 60-69 and over 70
 
Medical information
 
Please detail below any important medical information or disabilities that our coaches/ coordinators should be aware of (e.g. epilepsy, asthma, diabetes etc.)
 
Name Condition / Details
   
   
   
 
Emergency Contact details
Please indicate person(s) who should be contacted in case of an accident/incident:
 
Contact name
Emergency contact number
 
I accept the below club terms and conditions
Please accept my/our application for Wreake Runners membership.  I/we agree to abide by the rules of the Club and agree that neither the Club nor any of its officers shall be responsible for any claim relating to accident, injury, damage, or loss sustained by me/us during any Club activity.
   
Please tick box if you DO NOT wish photographs or information to be used on the internet or other media.
 
Payment
 
How will you pay?



 
 

run@wreakerunners.co.uk
Adults:
Tuesday 6:45pm
Thursday 6:45pm
Juniors:
Saturday 10:30am

Wreake Runners based in Syston, Leicestershire
Map to Wreake Runners Leicester
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