Gt Yarmouth & District Athletics Club
Wellesley Recreation Ground
Wellesley Road Great Yarmouth
www.gydac.co.uk
Norfolk
NR30 1EY
MEMBERSHIP APPLICATION FORM
1 April 2017 - 31 March 2018
Please complete this form in BLOCK LETTERS and send a cheque made payable to GYDAC
to the Membership Secretary, 2 Provan Crescent, Belton. Gt. Yarmouth. Norfolk. NR31 9LW
OR pay at the Club
April - Mar *£29
Oct -Mar *£19
(*Includes compulsory membership registration (£14) to England Athletics )
Associate members = Voluntary contribution
Surname
First name
Title
Address
Postcode
Home tel no:
Mobile
E-mail
Date of birth
email is used to circulate club and event information
Age on 31st Aug 2017
Ethnic origin
First claim EA affiliated club if not GYDAC
Contact name and telephone number in case of emergency
Type of membership
Fee enclosed
New / Renewal
£29
£19
*Other
Athlete / Second claim / * Volunteer
(Please delete as appropriate)
UKA reg no: (if known)
PLEASE GIVE DETAILS OF ANY MEDICAL CONDITIONS
Doctors Name and Tel number:Declaration
I have read and understand the safety advice and agree to abide by the Club 'Code of Conduct' and the
Rules for competition as determined by UK Athletics.
I agree that the club can use the personal data on this form for administrative purposes
Athletes signature
Date
(Also parent/guardian signature if under 16)
Date