New/Renewal Membership Form - Pickering Running Club 2020-21 Annual Membership £23 Membership to include England Athletics £38 Your email address Membership Type Annual Membership Membership to include England Athletics Title/Name Title Title TitleMissMsMrMrsDrOther… Enter other… First Name Middle Name Last Name Address Address Address 2 City/Town County Post Code Date of Birth Please enter your date of birth Your best contact Phone Number Either a landline or mobile, whatever is best should we need to contact you Details of who you want contacting in an emergency Name Telephone No. Please tell us how you have paid BACS Pickering Running Club Sortcode 60-16-30 Account No. 72451394 Cheque Payable to Pickering Running Club. Please give your cheque to Amanda Welburn-Smith or post to Simon Tyrell, Mill Farm, Rosedale, Pickering, YO188EW Date Paid Bank transfer or cheque please state date paid. Payment Reference When paying by BACS, please enter your payment reference in the field above. This will help us to identify your payment. By ticking this box I agree to abide by the club rules as detailed in the Membership Rules and I accept all risks assocated with running. I waive and release Pickering Running Club from all claims and liabilities of any kind from my participation in the club. I agree By ticking this box I agree to the club keeping this personal information and passing it to England Athletics if I have purchased England Athletics membership. We will not pass this information to anyone else unless you ask us to, and will delete it at your request or if your membership ceases. I also agree to photographs of myself being used appropriately by the club. I agree Detailed Membership Rules Our membership rules are given in detail here. Our Safe Running Guidelines are here. Pickering Running Club Facebook Group Please tick here if you wish to join our Facebook group Join Facebook Group
