Membership Application Lancing Eagles RC

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Please refer to the privacy policy which can be found on the website https://www.lancingeagles.co.uk/sitefiles/27/1/3/271399/2018_Privacy_Policy.pdf which details on the information we collect about you, how your information is processed, how we use your information and your rights. Details completed on this form will only be used internally, unless;
* you choose to be registered as a member of England Athletics where some information will be shared to register you or
* details of medical information that will only be passed onto the emergency services in the case of a medical emergency

Email *

Full Name *

Address *

Please enter full address including Post Code

Phone number *

Please enter your Mobile Telephone number if you have one

Email *

Gender *

Female

Male

Prefer not to say

Other:

Date of Birth *

YYYY

Emergency Contact Details

These details will only be used in the case of a medical emergency

Emergency Contact Name *

Emergency Contact Telephone Number *

Health Considerations

If you wish to notify us of any relevant medical history, such as epilepsy, diabetes or a history of heart problems, medication or allergies, that will only be passed onto the emergency services in the case of a medical emergency, please detail them here. If there is any relevant changes to your health that you would like us to pass to the emergency services, please let either the club or race leaders know.

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