Salford Harriers and Athletics Club [Junior Membership]

Salford Harriers and Athletics Club
Junior membership form
The Club is committed to ensuring that equity is incorporated across all aspects of its development. In doing so it acknowledges and adopts the UKA definition of sports equality.
I declare that i am an Amateur according to UKA rules and hereby apply to become a member of Salford Harriers & Athletic Club and agree to abide by the rules of the Club.
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Gender*

FemaleMaleNon-binaryTransgenderPrefer not to sayOther
Ethnicity*
Address*

Street Address

Street Address Line 2

City

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Detail below any important medical or disability information which the Club should be aware of. (If you use an inhaler what type is it?)*

Are you currently / have been a member of any affiliated club (England Athletics, Fell/Hill).*

Yes (if yes please complete the box below)No
Previous club details
Club: Date of resignation (if applicable): If you are a current member of a EA affiliated club, have you completed the online 'change of club form' on your EA portal: Yes/No If you have not submitted a 'change of club form' on your England Athletic portal, you will need to do so before we can accept your transfer
Disciplines in which you expect to participate*

Road RunningCross CountryTrail, Fell & Mountain Running

Over 11s only - EA Membership

When you become a member of, or renew your membership with Salford Harriers & Athletic Club, you will also be registered as a member of England Athletics (you will have to register with England Athletics if you ever compete for the Club in competition under UKA Rules). We will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called MyAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics please contact dataprotection@englandathletics.org. The affiliation fee for England Athletics is included within your membership fee.
If you do not tick the box below and then decide to compete for the club, we will need to register you with England Athletics and we will inform you at that time.

Please register me EAPlease do not register me with EA
I confirm that I am eligible to compete under UK Athletics Rules

Yes
I accept that my personal data will be held by the club securely as required.

YesNo

The club now uses Spond to keep members up to date with club news and events. To join the group you can download the Spond app via https://group.spond.com/FPLHE
Signature [Parent or guardian]

Clear
Date

MonthDayYear
Date
Membership fees

Details of fees can be found here. The cost of membership is reviewed every year at the AGM in November.

Please select your payment method below. If you require any assistance please contact salfordharriersjuniors@gmail.com

Please note, we will not process your application until we have received your membership fees.
Payment

By bank transferCheque
Payment by bank transfer is preferred and our account details are

Natwest - Salford Harriers and Athletics Club

A/C 29220114

S/C 01-03-38

Payment by cheque made payable to 'Salford Harriers' and sent to Jo Barber, 32 Agecroft Road Salford M27 8UE
email: flaherty_jo@hotmail.com
Should be Empty:

Salford Harriers and Athletics Club