Registration Form

Personal Details = required

Full Name

Home Address

Home Phone

Work/Other Phone

Mobile Phone

Email Address

Alternate Email

Date of Birth

Gender

Male Female

Occupation

(Please indicate if you would be willing to help the club should it need your expertise.)

Membership Start

When would you like your membership to start?

At the start of the next season 2018/2019 - Expires 31st March 2019

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost
	Full Member - New (inc England Athletics Registrn) The extra £10 fee allows us to register you with England Athletics so that you are able to take part in the York Summer Road League and PECO Cross Country League etc(entry fees apply) Only available to new applicants over the age of 18.	£40.00
	Full Member - New members Any new members who join after Jan 1 will pay the full subscription (i.e. current subscription for that year) but their membership will run for upto 15 months (i.e. until Mar 31 of the following year) Only available to new applicants over the age of 18.	£30.00

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://www.myclubhouse.co.uk/YorkTriathlon/Home/TermsAndConditions) and the Privacy Policy (https://www.myclubhouse.co.uk/YorkTriathlon/PrivacyPolicy;).

Signature

Date

Please return completed forms to: Miss Rachael Holmes, Moss House, Church Lane,, Ellerton, YORK, East Yorkshire, YO42 4PB

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