OUTriC Membership Form 19/20

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First Name *

Surname *

Oxford Email address *

N/A if you do not have one

Non-Oxford email address *

Phone number *

College *

N/A if you don't have one

Medical conditions

Please list any medical conditions or ailments that the club should be aware of. If none please type N/A. All information will be treated confidentially.

Status at Oxford university *

Matriculated Oxford Uni student

Alumnus/Alumna

Associate

Non-Matriculated student eg. visiting student

Oxford Brookes student

Staff member

Other:

OSS Number *

The number above the expiry date on a bod card, NOT above the barcode.

Gender *

Female

Male

Prefer not to say

Other

Emergency contact name *

Emergency contact number *

Disclaimer *

I have read the Oxford University Triathlon Club's Constitution and Code of Conduct (available here https://www.outric.co.uk/club-documents). I understand them fully and agree to abide by them.

Yes

Required

Payment bracket *

2019/20 Fully matriculated Oxford Student - £60

2019/20 External membership - £65

Hillary and Trinity only - £45

Alumni NOT based in Oxford/training regularly with the club - £20

Have you paid? *

This can be done here https://www.outric.co.uk/join-outric. Please do not fill in this form unless you have already paid. If you have any issues, questions or queries then get in touch with our treasurer, Emma: emma.rowland@exeter.ox.ac.uk

Paid

Do you consent to us sharing this information with Oxford University Sports Federation? *

Data provided will be shared with the Oxford University Sports Federation for reporting and compliance purposes and in order for them to provide appropriate access.

Yes

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