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FORENAMES: |
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ADDRESS: |
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POST CODE |
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TELEPHONE NO. |
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DATE OF BIRTH |
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Are you a first
claim member of another athletic/running club? Yes/No
If yes, please give
club name
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Proposed by:
___________________________ Seconded
by: ____________________
(Member) (Member)
Declaration: I declare that I am medically fit and that I
intend to run entirely at my own risk and confirm that Romsey Road Runners
shall not be liable for any accident, injury, loss or damage as a consequence
of my participation as a club member. I
declare that I am an amateur according to UK Athletics rules.
I consent to my address and telephone number being available to other
members of Romsey Road Runners
Please make cheques payable to “Romsey Road
Runners”.
DATE: _________________ SIGNED:
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