East Essex Triathlon Club Membership Application 2010

PLEASE READ THE FOLLOWING CAREFULLY BEFORE REGISTERING FOR MEMBERSHIP

This form can be used for Adult and child membership, the cost for adults is £25 (renewal is £20 if paid before 31 January 2010). Children and adults aged 21 or less at 31 December 2010 can pay the reduced rate of £6.

Please enter all details below accurately; when you hit "Submit" the details will be passed to registration. You will receive an email within 7 days confirming your membership has been processed and will include payment details. If you do not receive a confirmation email, please send an email to membership@east-essex-tri-club.co.uk.

Please take particular care when entering details because this is how your membership will appear. Take special care with your email address; if this is incorrect you will not receive an email and so will not be able to take up your membership.

Also please be aware that it is a condition of membership that you will be willing to volunteer to marshal at least once at an East Essex organised event, receipt of payment assumes acceptance of this criteria

First Name:     

Surname: 
Sex (m/f):  Date of Birth (dd/mm/yyyy) Day: Month:  Year:  

Email Address:

(for children use parent's email address, not the child's)
Address Line 1:
Address Line 2:
Address Line 3:
Post Code:
 
Home Telephone:       Work Telephone:     
Mobile Telephone:   
 
Emergency Contact Name 1: 
Emergency Contact Number 1:   
Emergency Contact Name 2:   For Child membership only
Emergency Contact Number 2:    For Child membership only
 
 
School (Junior Members only)
400m Swim Time (If unknown, leave as 00:10:00) Adult Members only
Triathlon England No (if applicable):  
Occupation:  
Ethnic Origin:
   
Medical Conditions (please state if you use an inhaler):
Registered Disabled?: Specify details under Medical Conditions
   
Do you wish to register East Essex Tri as your first claim UK Athletics Club? 
Do you want membership of UK athletics through EETC?  For those paying £6 membership this option will cost an extra £5
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