Shaftesbury Barnet Harriers
Application for Membership
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 [ ] Officiating [ ]
Application requested : First Claim ( ) Second Claim ( ) Higher Competition ( )
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 £50 (includes club vest and shorts/crop-top and hot pants)*
Under 20 £45 (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
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 have not competed at an unregistered meeting or, if I have so competed, I have since been reinstated.
Date of application: ………………………… Signature:…………………………………
Parent/Guardian’s signature (if under 18) ……………………………………………………………………
Proposed by: ……………………………………… Seconded by: ………………………………..
Membership Secretary: ……………………………………………………………………………………...
When completed this form should be sent to:
Ladies: Bryan Smith, 46 Tudor Manor Gardens, Garston, Watford, Herts WD25 9TQ
Men: Geoffrey Morphitis, 55 Lancaster Avenue, Hadley Wood, Barnet, Herts, EN4 OER
Boys: Tony Smith, 10 Shenley Hill, Radlett, Herts WD7 7BB
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