Club membership 2021 SENIOR NEW OR LAPSED MEMBERS

This form is for SENIOR club membership for NEW or LAPSED MEMBERS (those that did NOT have membership in the 2020-21 year). Age 18 and above @ £49 per year.
Entrant details
Name:
Address:
Postcode:
Email:
Telephone number:
Date of birth:
Gender:
Male
Female
Extra: If you are First Claim to another club, please provide club name
In case of emergency
Friend/relative name:
Friend/relative Phone:
You must provide this information if you have a condition that may affect you whilst running or those running with you. This information will be kept confidential, but if your condition is sensitive or if you would rather not fill in this online form you are welcome to speak directly to a club official instead. Please write "none" if you have no known health issues:
Medical issues:
Declaration

Newmarket Joggers is a Company Limited by Guarantee. This is a legal not for profit entity and each member of the club is a guarantor of the company, with the maximum potential liability of any individual member/guarantor in the event of the company being wound-up, being limited to GBP1.00. Please contact any committee member if you would like any further information.

I agree that Newmarket Joggers will hold the above details on computer for club administration and some details (not medical) may be passed on to England Athletics for affiliation purposes.

As a member of Newmarket Joggers I agree to comply with all policies and codes of conduct as laid out by UK Athletics (https://www.uka.org.uk/).

I understand that I participate in club activities at my own risk and that neither Newmarket Joggers nor its members shall be held responsible for any injury, loss, damage or action claim as a consequence of my participation.

Agree

Newmarket Joggers' on-line payment processor is NoChex. After completeing this form, you will be passed to NoChex, who will take your credit or debit card details. Please be assured that at no stage do Newmarket Joggers have access to your card details.

Newmarket Joggers is a (not for profit) Company Limited by Guarantee (company number 11937347). Registered office: The Old Courts, 147 All Saints Road, Newmarket, Suffolk, CB8 8HH