ORION HARRIERS

APPLICATION FOR MEMBERSHIP

To the Honorary Secretary:

I would like to become a member of Orion Harriers, and would be grateful if my application could be placed before the members of the Committee.

PLEASE PRINT CLEARLY IN CAPITALS

SURNAME ……………………………..FORENAMES …………………………………………………

Preferred Name ……………………………Date of Birth ………………………… Place of Birth …………………………

If place of birth in London please say exactly where - as special rules apply.

POSTAL ADDRESS: NAME/NUMBER/STREET/ROAD etc …………………………………………….

TOWN ………………………………….COUNTY ………………………………….

PostCode……………………..Contact phone number……………………… email Address……………………………

Are you a member of any other clubs? If so, give details…………………………………………………………………..

Are you a student? If so, where?………………………………………………………………………………….

I hereby declare that:
    1. I am an Amateur athlete
    2. I will abide by the rules and regulations of the current UK and World Athletic governing bodies.
    3. Should I be elected, I will abide by the Rules of the Club (which are openly displayed in the clubhouse and which
       are obtainable from the Membership Secretary), and to pay the subscriptions as they become due,
       and all monies due from me to the Club, until I give notice of resignation.
    4. I understand that the details that I have provided above will be entered on a computer database for Official club
       use only, and that they will not be distributed or made available to any other party.

Signature of Candidate ………………………………………………

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PROPOSER (in BLOCK letters)…………………………...SIGNATURE OF PROPOSER……………………………

Proposer should write a few notes below about the applicant, ie. Participation in sports/past clubs etc

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SECONDER (in BLOCK letters)……………………………SIGNATURE OF SECONDER……………………………

Committee signatures …………… …………… ………….. ………….. ………….

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Subscription: £…………… enclosed.         Date of Election to Orion Harriers: …………………..