Membership Renewal 2008

 

If you wish to renew your membership, please complete the renewal section. Please mark clearly any details which have changed, particularly your email address.

If you no longer wish to be a member of the club, please complete the resignation section.

Please return the signed, completed form to John Reid, Treasurer & Membership Sec. 15 Eldridge Place, Corsham, Wiltshire. SN13 9UN  with a cheque for your membership fee made payable to "Corsham Running Club"  firmly attached (if you are renewing)

Renewal section

First name

 

Last name

 

 

Address

 

 

 

Postcode

 

Email address

 

Telephone

 

Date of Birth

 

Please write down your personal bests if you have them :

Distance

Lifetime

Year

For Age Group

Year

Age groups

Under 35

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

Over 65

5k

 

 

 

 

10k

 

 

 

 

½ Marathon

 

 

 

 

Marathon

 

 

 

 

Please circle the appropriate fee                                            Reduced rate if paid before 1/3/2008

Adult rate                                                            £20.00                                      £15.00

Junior rate (under 18 on 1/1/2008)                        £10.00                                       £7.50

Family rate                                                          £40.00                                      £30.00

Would you like a new membership card

Yes

 

No

 

Do you wish your name and email to be shown on the website ?

Yes

 

No

 

Signature

 

Date

 
                   

Resignation section

I no longer wish to be a member of Corsham Running Club

Signature

 

Date

 

 

Corsham Running Club is a non profit making club and is exempt from registration under the Data Protection Act 1998