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Nuneaton Harriers - Annual Membership Form
1st April 2021 - 31st March 2022
You will receive an email giving you the information for payment of membership fee by bank transfer
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Title
*
Mr
Miss
Mrs
Other:
Address
*
Your answer
Date of Birth (dd/mm/yyyy)
*
Your answer
Age On Application
*
Your answer
Birthplace
*
Your answer
Home Phone Number
*
Your answer
Mobile Phone Number
*
Your answer
Do you wish to be 1st claim or second claim member
*
1st
2nd
Previous/Other Athletic Club
Your answer
Nuneaton Triathlon Club Member
*
Yes
No
Do You wish to be a competing or non-competing member
*
Competing
Non-Competing
Did you pay for membership fee in 2020
*
Yes
No
Dont Know
What type of membership are you applying for
*
2021 Member EA Fee Only - £15.00
Child under 11 - £22.50
Junior 11 - 17 yrs - £37.50
Senior 18 - 60 yrs - £42.50
Concession 60+ - £27.50
NuneatonTri Club Member - £27.50
2nd Claim / Non Competing - £27.50
Family Membership £110.00
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