the Membership Renewal Form

Club Membership Number (on previous membership card) ……………………………………………………….
MEMBERSHIP RENEWAL FORM
Brighton and Hove
Athletic club
Please use BLOCK CAPITALS when filling in this membership form and
return to the membership secretary
Mr Mark Donaldson, 167 Gibbon Road, Newhaven, East Sussex, BN9 9ET.
Email: [email protected]
Telephone
01273 512151
Club membership fees (ages as at 1st January last)
All fees include the England Athletics affiliation fee of £12 (not
applicable to Under 11’s)
The membership year runs from 1st January to 31st December. New
members pay a reduced fee for their first membership if joining after July.
If joining from November 1st onwards they pay the full annual fee but this
gives membership until December 31st the following year.
If joining before
August
Joining from 1st
August
£16
£8.00
£32
£22
17-60
£44
£28
Over 60,
unwaged and
full time
students
£36
£24
Please circle
Age
the amount
you are paying
under 11
11-16
SECOND CLAIM: All second claim athletes pay £10 for membership.
Please send payment by cheque payable to Brighton and Hove City Athletic Club
The completed form and cheque should be sent to the membership secretary as above.
For Office Use only
Membership
number
EA number
Membership form
If you are over 16 please complete only sections A,D,E,F
PLEASE COMPLETE ALL DETAILS IN BLOCK CAPITALS & RETURN WITH YOUR
SUBSCRIPTION TO: MR MARK DONALDSON,167 GIBBON ROAD, NEWHAVEN, BN9 9ET
SECTION A: ATHLETE DETAILS
First Name
Surname
Address
Postcode
Telephone
Mobile Number
(If over 16 years of age)
Date of Birth
Email Address
(DD/MM/YY)
(If over 16 years of age)
Address of
School/ College
Postcode
Are you a member of any other sports club?
(If yes, please state which club and which sport)
County of Birth
Preferred Events
SECTION B: PARENT/CARER DETAILS
If you are under 16 years of age, please ask your parent/carer to complete the complete the
following section.
First Name
Surname
Address
Postcode
Telephone
Email Address
Mobile Number
NOW PLEASE CONTINUE THE FORM OVER THE PAGE
SECTION C: PARENT/CARER HELP
One of the conditions of membership of Brighton and Hove Athletic club is that we ask all parents
/carers to help out at club events for a few hours each year. Please tick areas that you would be
interested in helping with. The relevant club person will then contact you to see which events you would
be able to help at. If there is a specific area of expertise that you feel you can bring to the club, please
also indicate below.
Helping at athletic meetings
Assisting Training
Refreshment area
Team management
Fund raising
Supervision of athletes
Facility/Equipment maintenance
Committee post
Website management
(contact Mike Ellis-Martin or Bob Willows for
more information)
Promotion and marketing
Helping Officials
Other (please specify)
SECTION D: MEDICAL INFORMATION
Please detail below any important medical information that our coaches/junior coordinator should be
aware of (e.g. epilepsy, asthma, diabetes, allergies etc.) Please do not leave blank – if there is no
information please write ‘None’.
SECTION E: EMERGENCY CONTACT DETAILS
Please insert the information below to indicate the persons who should be contacted in event of an
incident/accident.
Emergency Contact One
Name
Emergency One Contact
number:
Emergency Contact Two
Name
Emergency Contact Two
number:
It may be essential at some time for authorised persons acting on behalf of the club to have the
necessary authority to obtain urgent treatment which may be required whilst at representative club
competition or training. Please sign below to give your consent to emergency treatment being given to
the named athlete on this form by trained personnel
Signature
Print Name
SECTION F: ATHLETE AGREEMENT
By returning this completed form, I am willing to abide by the club code of conduct for athletes and
agree to always behave in the manner befitting a Brighton and Hove Athlete, when attending club
events.
Signature
Print Name
SECTION G: PARENTAL/CARER AGREEMENT (PLEASE IGNORE IF ATHLETE OVER 16 YEARS OF
AGE)
By returning this completed form, I agree:
1. To the named athlete taking part in the activities of the club.
2. That I have read and agree to abide by the club code of conduct whenever I am present at club
activities or competition
3. To helping out at club events through the year.
4. To taking responsibility for my child until they are collected from the clubhouse by their coach at the
start of their coaching session and delivered back at the end.
Signature
Print Name
`