MEMBERSHIP APPLICATION
FOR THE YEAR
1 APRIL 2012 TO 31 MARCH 2013
CATEGORY
GRADE CODE
Adult Club-Membership only incl Marathon Clinic see below
Club Membership plus Athletics NZ Membership
Masters Men/Women
35+ yrs
MM or MW
Senior Men/Women
21 - 34 yrs
SM or SW
Junior Men/Women 20
18,19, 20 yrs
JM or JW
Junior Men/Women 17
15,16, 17 yrs
JM or JW
Boys/Girls
9 - 14 yrs
B or G
Boys/Girls
5 - 8 yrs
B or G
Tiny Tots
2 – 4 yrs
B or G
Honorary or Elected Member
HO
Apparel
Adults Walkers Tee (short sleeves)
Adults Running Singlets
Adults Windbreaker Jackets M-XL
Juniors Running Singlets Size 6-14
Juniors Tracksuit sets Size 10-16
Qty
AMOUNT
$51.00
___
$___________
$102.00
$102.00
$66.00
$51.00
$31.00
$26.00
$15.00
Nil
$35.00
$35.00
$90.00
$15.00
$50.00
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___
___
___
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___
___
___
___
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$___________
$___________
$___________
$___________
$___________
$___________
$___________
$0.00
$___________
$___________
$___________
$___________
$___________
TOTAL including GST
$___________
Paid by (circle one) - Cheque / Cash / Internet Banked date, name, ref: _______________________________
PARENT TRAINING: All parents of Children attending Summer Athletics are expected to help at Children’s club
nights when they are available. Training will be provided to all parents and helpers at pre-arranged sessions.
MARATHON CLINIC: For first-time members, your membership will cover you from the Clinic start being the 2nd
week of January, through to and including the full financial year in which the Rotorua Marathon takes place.
* Recommended GP health check visit for purposes of Marathon training (circle one) - Done / No / Will do
* What distance events have you completed before (circle one) – Marathon / Half Marathon / 10km / 5km / None
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GENERAL NOTES:
1)
Joining as an adult Club member only means that you are not registered with Athletics New Zealand (ANZ) so
cannot compete and/or gain placings in inter-club track or harrier events. However you can take part in all
ordinary club races and can enter open (public) events like the Half Marathon & Marathon etc. If in doubt
please ask a committee member to check for you.
2)
All ANZ registered members will receive a numbered and named registration badge. This must be worn for all
events other than open (public) type events. The Athletics Waikato Bay of Plenty Centre must receive your
registration fee before the registration badge is issued. You should allow both the Club and the Centre at least
two weeks to process your registration - don't leave it until a day or two before the event for which you
require the badge, because you will simply not be able to compete.
3)
Athletics New Zealand age grades for Children (up to 14yrs) are based on age as at 31st December in the year
of Membership shown above. Grades for Men & Women (15-34yrs) is age as at 31st December of the calendar
year you are currently in (will change at the beginning of each year). Grades for masters (aged 35+) competing
in Masters Athletics events, grade is determined by age on the day.
4)
Please pay by cheque payable to The Lake City Athletic Club, or the exact cash amount, or pay by internet
transfer to the club’s Westpac bank account # 03-1552-0095487-00 (must record your name as a reference on
the transfer). You must still send in this form completed and signed by mail to PO Box 2136 Rotorua, or
scanned and emailed to [email protected] before your application can be processed.
PTO
www.lakecity.co.nz
PO Box 2136, Rotorua
Membership Form
Person 1
Person 2
Person 3
First Name
Surname
Date of Birth
Age per Grading Rules
(circle)
Male/Female
New Member?
Y/N
Person 4
Male/Female
New Member?
Y/N
Person 5
Male/Female
New Member?
Y/N
Person 6
First Name
Surname
Date of Birth
Age per Grading Rules
(circle)
Male/Female
New Member?
Y/N
Male/Female
New Member?
Y/N
Male/Female
New Member?
Y/N
ADDRESS
Town/City
Phone Numbers (all)
Email Address(es)
Parent/Guardian Names
Privacy Act 1993
I hereby apply to join the Lake City Athletic Club (Inc) and agree to abide by its rules as stated in it’s Constitution. I also agree, in
compliance with the Privacy Act 1993, that my personal details as outlined in this Application Form be made available to Athletics
New Zealand either through Athletics Waikato Bay of Plenty or direct, for the purpose of its administration of the sport of athletics
in New Zealand.
Signed:- .............................................……................………….............................
Date:-…………………………….
- - - - - - - - - - - - - - - - - - - - - - - - -CUT HERE & HAND IN TOP SECTION - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
GENERAL NOTES continued…:
5)
The Club Uniform for Adults is either the Blue Walkers Tee with short sleeves, or the Runners Singlet in blue,
white and black. The Club Uniform for Childrens is the new Juniors Running Singlet in blue, white and black.
These must be worn with plain black shorts or plain black lycra legging shorts.
Club uniforms can be purchased by arrangement with Kerris Browne (phone 021 753691). Please make
arrangements for purchase well before you require it. Club members are encouraged to wear club uniform
during all events (eg club nights, half marathon, publicity photos) and must be worn in inter-club events when
determined necessary (eg Ribbon Days, NZ Road Relays).
6)
Cancellations – Seniors T&F and Harriers rarely ever cancel, even if its raining. For Childrens, phone the
hotline on 349 2994, dial 5924 for Cancellations. Otherwise checkout the Cancellation Notices on the
www.lakecity.co.nz website. For Children’s events, look at Lake City Kids newsletter, or the Events page.
7)
Summer Track & Field Oct-March - Club Nights are held at the #2 Grounds, International Stadium, Devon St;
th
a) Registration is Saturday Sep 29 at the Clubrooms 10am-12noon, if you have not already registered.
b) Tiny Tots to 11yrs – Tuesday evenings 5:15pm sharp starting October 16th 2012
c) Introduction to Teens 12yrs+ - Wednesday evenings 5:15-6pm starting October 17th
d) Teens & Adults 12yrs+ Club Night – Wednesday evenings 6pm starting October 17th
e) Development Squad for competitive athletes - times to be advised by Coaches.
www.lakecity.co.nz
PO Box 2136, Rotorua