Title MrMrsMsMissDrOther
Sex MaleFemale
Name
Date of Birth (DD/MM/YY)
Address
Postcode
Email
Telephone (Home)
Telephone (Mobile)
Next of Kin
Next of Kin Contact Number
Are you a member of any other athletics club? YesNo
If yes, please give club name
How did you hear about us? Word of mouthPressSaw Hayle Runners outOther
Do you have any allergies, medical conditions or disabilities which may affect your participation in this activity or that you feel we should be made aware of? YesNo
If yes, please consult your doctor before you become more physically active and give brief details here:
How would you describe your ethnic origin? White-BritishWhite-OtherBlack CaribbeanBlack AfricanAsianChineseMixedOther
I give permission for you to store my details and, when necessary, share them with other Club members for Club purposes. YesNo
I agree to the use of photographic images of the Club’s activities for promotional and reporting purposes and for use on the website. YesNo
T-shirt size (for club vests and race goodie bags): SmallMediumLargeExtra Large
Address:Lorem ipsum street 10/2 New York
Phone:+97 46 543232
Fax:+97 46 543231
Address:Labore street 8/6 New York
Phone:+97 46 543282
Fax:+97 46 543281
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