Contact

Title
 Mr Mrs Ms Miss Dr Other

Sex
 Male Female

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?
 Yes No

If yes, please give club name

How did you hear about us?
 Word of mouth Press Saw Hayle Runners out Other

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?
 Yes No

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-British White-Other Black Caribbean Black African Asian Chinese Mixed Other

I give permission for you to store my details and, when necessary, share them with other Club members for Club purposes.
 Yes No

I agree to the use of photographic images of the Club’s activities for promotional and reporting purposes and for use on the website.
 Yes No

T-shirt size (for club vests and race goodie bags):
 Small Medium Large Extra Large