East Essex Triathlon Club

Membership Form 2008

*Name:

*Date of Birth:

*Address:

BTF No:  

(if applicable):

*Home Phone:

Mobile:

*Post Code:

Work Phone: 

Occupation:

*Ethnic Origin:

Email Address:

Emergency contact Name:

Emergency Contact No:

EETC pay for entry in 1 of 2 events for those paying the full adult rate. The championship race is Harwich, but club entry for this race is now full for 2008. The alternative race is Blackwater Triathlon on 14th September 2008. You can enter this race through the standard Blackwater Triathlon entry process and claim your BTF member entry fee back from the club.

I am Registered Disabled:  

Yes / No

Medical Conditions:

Are you a member of another England Athletics affiliated club?

Yes / No

If yes, is East Essex Tri your first claim club for UK Athletics events?

Yes / No

East Essex will be affiliating to England Athletics and must enroll all first claim members with them (we must pass them contact information for you). If you do not wish to become a member of England Athletics please indicate so and we won’t pass on your details (you will not be able to run in any event sanctioned by England Athletics as an East Essex Tri Club member).

I do / do not *wish to become a member of England Athletics.

* delete as applicable

Membership fee:

Adults £40

Age 18 – 21 - £6

Under 18s (Use Childrens form)

Cheques payable to "East Essex Triathlon Club"

I understand that I am requesting full membership of the East Essex Triathlon Club. I understand that the club is committed to promoting the sport of Triathlon and part of this commitment includes the running of four or more events annually. I agree that I will participate in marshalling in at least one of these events.

Send to: Steve Fisher

Signed: __________________________________

353 Outwood Common Road

Billericay

Essex

CM11 2LZ