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Great Bentley Running Club New member registration - 2019-20
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* Indicates required question
Title (i.e Mr, Mrs, Miss, Dr, etc)
*
Your answer
Forename
*
Your answer
Surname
*
Your answer
Gender
*
Female
Male
Prefer not to say
Other:
Date of birth
*
MM
/
DD
/
YYYY
Age at 1st April 2019
*
Your answer
Email
*
Your answer
Address
*
Your answer
Phone number
*
Your answer
Membership type
*
Junior runner - No charge (incl England Athletics registration)
Runner - £25 (incl England Athletics registration)
Honorary Runner - No charge (incl England Athletics registration)
Social - £10
Required
I consent to these details being held by the Club Secretary and Membership secretary and being disclosed to England Athletics for the purposes of membership and added to a closed Google group used for emailing all club members.
*
I give consent
Required
Membership of another Athletic/ Running Club
Yes
No
Clear selection
If yes - please state the name of any previous club and your status with them (ie first or second claim)
Your answer
Contact in an emergency - Name, Relationship to you and contact number
*
Your answer
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