Knox Road Runners Membership Application

Membership Application/Renewal

Knox Road Runners Incorporated
Personal Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Mobile*
Please enter a valid phone number.
Date Of Birth

DayMonthYear
Email*
example@example.com
I give Knox Road Runners Inc. permission to publish my email address and phone number to other members of the club*

YesNo
Emergency Contact
Emergency Phone Number
Please enter a valid phone number.
Medical Conditions/Injuries
New Members
Brief Running History
How Did You Hear About Knox Road Runners?
Existing Members
Suggestions/Ideas
All Members
Are you already a registered member of Athletics Victoria?*

YesNo
If yes, which club are you associated with?
I give my permission for my photographs and images to be used by Knox Road Runners Inc. on social media channels to promote the club (tick box to opt OUT of photos on social media)

I DO NOT consent for my photos and images to be posted on social media
I agree my personal details will be provided to Athletics Victoria for the purposes of being registered for insurance. I understand that my personal details will not be provided to any other third party with out my prior consent.

As a member of Knox Road Runners Inc. I agree to abide by the regulations of the club. I, the undersigned, in consideration of and as a condition of my membership of Knox Road Runners Inc, for myself, my heirs, executors and administrators, hereby waive all and any claim, right or cause of action which I or they might otherwise have for or arising out of loss of my life or injury, damage or loss of any description whatsoever which I may sustain as a consequence of my membership and participation
Full Name*

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Please click here to access Athletics Victoria to complete insurance and membership payment.
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Membership Application/Renewal

Personal Details

New Members

Existing Members

All Members