SRS Beginners Application Form 2009

Application Form Beginners 2009

Name:
Address:

Post Code:
Telephone: (daytime) Telephone: (evenings)
Email:
Emergency Contact - Name: Telephone:
Have you ever belonged to another running club?
Are you currently a member of another running club?
If so please name it here
What is your running experience?
Beginner ___ Some experience ___ Active in another sport ___
Medical information: Please write down ANY medical condition Southampton Running Sisters should be aware of e.g. back/knee injuries, high blood pressure, diabetes, asthma
.......................................................................................................................................................................................
......................................................................................................... Your date of birth.....................
PLEASE READ THE FOLLOWING CAREFULLY AND SIGN BELOW.
I ACKNOWLEDGE THAT IN PARTICIPATING IN THIS COURSE
I WILL NOT HOLD Southampton Running Sisters liable for any injury I might sustain. I undertake that I am enrolling on this course in good health at my own risk.
I understand that the course will be assisted by qualified coaches and helped by other Running Sisters.
SIGNED............................................. Date...............
Please return the completed form by post (fee enclosed) to:
Tina Dempster, Membership Secretary,
15 York Close, Horton Heath, Eastleigh SO50 7PX
I wish to enrol on the Running Sisters Beginners' Course
I enclose an advanced registration fee of £30 full fee/£25 concessionary fee*
* cheques (payable to Southampton Running Sisters)
or Postal Order only - no cash by mail,
Please enclose a stamped self-addressed envelope for acknowledgment if you do not have email.
NB: registration on the first day £35
Receipts will be available at registration