Online Membership Application Form
Senior membership is £32.50 (age 18-24) or 42.50 (age 25+) inc club vest
Junior under 19 as at 31st August in year of membership is 32.50 inc club vest

After submitting the form, you will be taken to the payment page and may pay by credit card or debit card

I apply to join ELY RUNNERS - Please select "1st Claim" or, if you wish to
retain main membership with another athletic club select  "2nd Claim"

Surname:

First Name:

Date of Birth (dd/mm/yyyy) 
e.g. 07/11/1975


Phone Numbers:   Home   

                                    Work    

                                 Mobile


Email Address:    Main  

                        Secondary (if applicable)


Home Address:

Address1: e.g. 10, High Street
Address2: e.g. Ely
Address3: e.g. Cambs
PostCode:                                                    e.g. CB1 1AA

Gender :

 

For Juniors:

Parent/ Guardian contact info:

P/G Name:

Name of a parent or guardian
 
Address & Phone numbers:

If different from junior member's address
 
Additional P/ G Name:

If you wish to give an additional parent or guardian contact, please do.
Additional Name Address & Phone numbers:


                 
If different from any of the above.

Further Runner Info (optional):

Person Bests:

Any Personal bests including distance, time, place and date achieved
 
Experience:

Brief details of any coaching, officiating & other athletic administrative qualifications & experience.
 
Privacy:

If you do not wish your photograph and/or name to appear on the club web site please state the extent to which you wish to remain anonymous. (Ely Runners will never publish your date of birth, home address, phone number(s) or email address without your explicit permission.)
Medical:


                 
Any relevant medical conditions you feel we should know about?


Unless notified to the contrary within 28 days, this application is deemed accepted by the Committee.
Membership will be valid after confirmation of payment has been received.
Membership enquiries to Richard Hill membership@elyrunners.co.uk

To confirm you have checked all the above details and that they are correct.
Select below "Yes I confirm the details are correct"

 

(Use the "Submit" button below to send your form)