Membership Form

We look forward to welcoming you into Plymouth Musketeers Running Club! To ensure we have the correct contact details for you, and to fulfil our legal obligations, please complete and submit this form.

ANNUAL MEMBERSHIP FEE
Annual membership runs from 1st April – 31st March. BACS payments Sort code 309668 Account No 00658704

Membership Type

EA Registration No.

PERSONAL DETAILS

First name

Last name

Address line 1

Address line 2

Town/City

Postcode

Phone

Date of birth

Country of birth

Gender

Other

IF YOU HAVE A DISABILITY
The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities’.

Disability details

Other disability

MEDICAL INFORMATION
Excluding any disability information given above, please detail below any important medical information that our leaders and coaches should be aware of and you wish to disclose (e.g. epilepsy, asthma, diabetes, allergies etc.) Please do not leave blank – if there is no information please write ‘None’. If you are new to exercise please consult your doctor before starting with the club.

Medical information...

EMERGENCY CONTACT
Please advise who should be contacted in event of an incident/accident.

Emergency Contact Name

Emergency Contact Phone

MEMBERSHIP AGREEMENT
By returning this completed form, I am willing to abide by the club’s codes of conduct, rules and policies, details of which are available on the club website. I also confirm that I understand that participation in any group or class is entirely at my own risk.

When you become a member of or renew your membership with Plymouth Musketeers Running Club you will automatically be registered as a member of England Athletics. We will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact dataprotection@englandathletics.org.

Please enter your name in capitals below to sign and confirm agreement...

Signature

Date

Thank you! We look forward to welcoming you to the club.