Membership

MEMBERSHIP APPLICATION FORM

MEMBERSHIP APPLICATION FORM* MEMBERSHIP RENEWAL FORM* CHANGE OF PERSONAL DETAILS FORM* * Delete as appropriate

Name: ……………………………………………………………………..
Date of Birth: ……………………………………………………………………..
Sex: ……………………………………………………………………..
Home Address: ……………………………………………………………………..
……………………………………………………………………..
Postcode: ……………………………………………………………………..
Home Telephone No: ……………………………………………………………………..
Mobile Phone No: ……………………………………………………………………..
Email Address: ……………………………………………………………………..

The annual subscription fee (2009-2010) will be £12 but if as an individual you also wish to be affiliated to EA then there will be an extra fee of £3 making a total of £15.
Members affiliated to EA will be able to enter the large national races (London, Great North etc.) without paying the non affiliated premium. They will also be eligible for the club draw for London Marathon places.

Do you wish to receive correspondence via Email  or Post 

Please leave your form in the Treasurer's box at the club or post it to:

Dave Higgs
Club Treasurer
12 Brick Kiln Lane
Shepshed
LOUGHBOROUGH
Leics
LE12 9EL