For Club use only
Membership No:
______/__________
Payment
BACS/ Cheque /
Cash
£
Ledbury & District Harriers
Membership application Form
Z
www.ledburyharriers.org.uk
Affiliated to England Athletics
Name:
________________________________________________________
Address:
________________________________________________________
________________________ Post Code: ______________________
E-mail:
________________________________________________________
Phone: Home
Date of Birth:
Mobile
___________________ Gender
Country of Birth: ___________
Club of Origin
Male / Female
Nationality:
(if you are not a 1st Claim member of LDH)
I permit my e-mail address to be used to send me regular club information. It will not be disclosed to third parties.
YES / NO (Delete as appropriate)
Membership is £25 a year which includes individual affiliation to England Athletics (EA). If you are already affiliated to EA through
membership of another club you can opt for non-affiliated membership at £15 per year
The Membership year begins on 1st April.
By signing and returning this form, I understand and accept that:


I am declaring that I am an amateur as defined by the eligibility rule of England Athletics.
I am fit and able, and take part in the Club’s activities entirely at my own risk and that I will be responsible for my own
safety whilst out running with the Club or when I take part in events as a Club member.
Standard membership: This includes UK Athletics affiliation fee of £13, which entitles you to many benefits,
including reduced race entry fees, eligibility to run in cross country leagues and discounts from many sports shops.
Renewal
£25
New Application
£25
Non Affiliated membership:
Renewal
£15
New Application
£15
Signed……………………………………………….Date…………………………….…………….
Please pay via BACS using your name as reference: Sort Code
20-45-45 Account No 83930297
Cash or cheque can be accepted, made payable to Ledbury & District Harriers.
Paid via BACS
Paid by Cheque
Paid by Cash
www.facebook.com/groups/ledburyharriers
Emergency contact
Please enter at least one name and number that we can contact in the event of an emergency.
Emergency contact details
Name:
Telephone Number:
Relationship to you:
Name:
Telephone Number:
Relationship to you:
Notes for all members
The ethos of our club is that no-one is left behind on club runs. If someone in the group is struggling you are
asked to muster from the front to the back but we except that sometimes you require a longer recovery as
well.
Your group leader is a volunteer who has agreed to set the pace and distance for the run and requires your
support to ensure the safety of the group.
Remember to think about safety, not just when crossing roads but also when running over uneven land, in
dusk or in the dark conditions. Wearing fluorescent/high visibility clothing is recommended.
Terms and conditions
By completing and submitting this form I understand and accept that: * I am declaring that I am an amateur
as defined by the eligibility rule of UK Athletics. * I take part in the club’s activities entirely at my own risk and
that I will be responsible for my own safety whilst out running with the club or when I take part in events as a
club member.
Tick the following box if you agree and sign again at the bottom of page.*
I accept the terms and conditions
Please return completed forms to:
Sue Kirk
36 Bank Crescent, Ledbury HR8 1AD
07855 424566
[email protected]
Signed……………………………………………….Date…………………………….…………….