SOUTH WEST VETERANS’ ATHLETICS CLUB

Affiliated to England Athletics, British Masters Athletics Federation and

Veteran Athletes Association of England

MEMBERSHIP APPLICATION FORM

PLEASE COMPLETE IN BLOCK CAPITALS

Surname... ... ... ... ... ... ... ... .......................... First name/s …..................................................

Address…………………………………………………………………………………………………

……………………………………………………………………………………………………….

Post code... ... ... ... ... ... ... ... .......................... Telephone No......................................................

E mail ...... . .. . .. ... ... ... ... ... . .. ... ... ... ... ... ………………………………………………………

Male/Female (delete as applicable) Date of Birth .... ........................................................

Note: If you belong to any other Athletic Club affiliated to England Athletics then you will be

Applying for Second Claim Membership. With no such club you will be First Claim for South

West Veterans’ AC and will pay according to your competitive status as below.

MEMBERSHIP CATEGORIES AND ANNUAL SUBSCRIPTION RATES:

First Claim - competing ………£15.00 First Claim - non-competing……£10.00

Second Claim members (all)………...£10.00 (delete as required)

Please give the name of your current affiliated Club (where applicable):

.... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... .. ... ... ... ... ... ... ... ...

Please circle your areas of interest: Track & Field Road Running Cross Country

Race Walking Officiating/Admin

I wish to apply for membership of South West Veterans’ Athletics Club and confirm that I am an amateur as defined by England Athletics. If elected, I agree to be bound by the Constitution and Rules of the Club and those of England Athletics. I acknowledge that the above information will be stored on a computer

Signed... ... ... ... ... ... ... ... ... ... .... ................ Date ……………………………....

Application form together with a cheque or crossed Postal Order payable to SWVAC,

supported by a photocopy of passport or birth certificate,

to be sent to:

Membership Secretary, Ken Ballam, 7 Sandford Court, 32 Belle Vue Road, BOURNEMOUTH, BH6 3DR