Shaftesbury Barnet Harriers
APPLICATION FOR MEMBERSHIP
A Community Amateur Sports Club - Registration Number: 00560 Allianz Park, Greenlands Lane, Hendon, London NW4 1RL
Affiliated to UK Athletics and England Athletics www.shaftesburybarnet.co.uk
Full Name: .
Address: .
. .. Post code: ... . . .
Tel: (Home) .. . . Tel: (Work) .. .
Tel: (Mobile) . E-mail .. . . . . ...
Date of Birth: . Male [ ] Female [ ]
Interests: Track & Field [ ] Road [ ] X Country [ ] Coaching [ ] Volunteering [ ]
Application: First Claim ( ) Second Claim ( ) Higher Competition ( ) EA Licence number
Name of any other athletic club that you have belonged to: ..
Date of resignation from that club: .. County of birth or County to represent ...
Joining fee: Over 20 £55 (includes club vest and shorts/crop-top and hot pants)*
Under 20 £50 (includes club vest and shorts/crop-top and hot pants)*
Supporter £30
* please indicate required size and colour as shorts/hot pants come in red or black.
Cheque to be made payable to Shaftesbury Barnet Harriers. The joining fee must accompany this form for membership to be accepted.
JOINING FEE DOES NOT INCLUDE THE ENGLAND ATHLETICS COMPETITION LICENCE FEE
I HEREBY DECLARE THAT THE FOLLOWING PARTICULARS ARE CORRECT AND COMPLETE:
1. I am an Amateur and eligible to compete according to the Rules and Laws of UK Athletics.
2. I will abide by the Laws and Regulations for competition issued by the Governing Bodies of Athletics.
3. I do / do not suffer from illnesses which would prevent me from either training or competing and which should be brought to the attention of the Club. (delete as appropriate)
4. I do / do not have any special requirements of which the Club should be aware. (delete as appropriate)
The Club will be in touch with you if you have answered positively to either question 3 or 4.
Date of application: Signature: .
Parent/Guardians signature (if under 18)
Membership application accepted / rejected .. .. ... Secretary
When completed this form should be sent to:
Ladies: Bryan Smith, 46 Tudor Manor Gardens, Garston, Watford, WD25 9TQ
Men: Geoffrey Morphitis, 55 Lancaster Avenue, Hadley Wood, Barnet, EN4 OER
Boys: Tony Smith, 10 Shenley Hill, Radlett, Herts WD7 7BB