POOLE RUNNERS MEMBERSHIP FORM
1st April 2024 to 31st March 2025

(Under 18s please complete U18 form.)

Personal Details

Title:

First Name:

Surname:

Address:

Post Code:

Nationality:

Date of Birth:

Email:

Phone:

Emergency Contact Details

Name and Contact Number:

Medical Details

Please briefly list any medical conditions that the club should be aware of (e.g. epilepsy, diabetics,
allergies, etc.) You may be asked to provide further details by coaches or club officials. Please do not
leave blank – if there is no information please write ‘None’.

Medical Information:

Running Background

Please select how best to describe you as a runner.

New to running/social memberNovice runnerExperienced runnerPrevious club member

Any further comments:

Membership Categories:

Full Member £37.00
Poole Runners club membership including affiliation with England Athletics. This allows you to enter road, cross country races and track and field events anywhere in the country as a Poole Runners member for the reduced entry fee. Plus entitlement to discounts from various England Athletics associated organisations.

'100 Club' Member – £4 per month via bank standing order to Poole Runners
Provides full Poole Runners club membership with England Athletics affiliation entitlements and the chance to win up to £50 in the monthly ‘100 Club’ draw.
Note: Open to new and renewing members for a period of two months from 1st April to 31st May 2024.

Family Membership – 15% discount off Poole Runners club membership (EA fee not discounted) For three or more family members living at the same address. (Therefore over 18 family membership = £18 less 15%, Total £15.30 per person plus £19 EA membership, Total = £34.30 each)

Social/Associate Membership or second claim – £18.00 – For social and non-competitive runners. Does not include EA registration. Therefore
“Unattached” levy must be paid for all event entries as a non-registered runner/athlete and entered as unattached/no club. Only full members are eligible to enter the club championships.

Select Membership Type:
Full Member100 Club MemberFamily MembershipSocial/Associate Member

First Claim Club

- Only if not Poole Runners. This is relevant if you wish to belong to
two UK Athletics affiliated clubs. E.g. if you are currently living away from your
primary or home town club.

First Claim Club Name

Declaration

I wish to apply/renew membership of Poole Runners. I declare that the club or any of its coaches/officials
shall not be liable for any accident injury, loss or damage as a consequence of my membership of Poole
Runners.

I am currently in good health and capable of taking part in running/athletics. Should any circumstances
change after joining or renewing I will update the club.

General Data Protection Regulation (GDPR)
When you become a full member of or renew your full membership with Poole Runners you will automatically be registered as a
member of England Athletics. We will provide England Athletics with your personal data which they will use to enable access to
an online portal for you (called MyAthletics). England Athletics will contact you to invite you to sign into and update your
MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions
about the continuing privacy of your personal data when it is shared with England Athletics, please contact:
dataprotection@englandathletics.org.
As a member of England Athletics you need to be aware of and agree to be bound by the UKA Anti-Doping Rules and agree to sign up to the Senior Athletes Code of Conduct. All details available on the EA website.
Social/Associate member’s details will also be held by Poole Runners.

I agree to my personal details submitted on this form being held by the club for a period of up to two
years after receipt, for the purpose of club administration only.

Access to my details may be made available to coaches and authorised officers of Poole Runners solely
to facilitate club activities. Examples of this may include, but not limited to:
- Race/Event entry
- Club member demographic surveys
- England Athletics Registration

I acknowledge and agree with the club’s ethos of fair play and inclusion for all its members. I agree that a
good standard of behaviour is expected always, from all members and families, when attending events or
training supported by the club.

I agree that I will abide by the club’s constitution: View Constitution (opens in new window)

I agree that any photographs, including my image taken at club activities may be used for publicity and to
promote the club.
I acknowledge that it is my responsibility to inform the club Chair should I not wish my photos to be shared on social media.
I consent to the club recording and publishing my race results for the purposes of
publicity and club competitions.

I have read & agree with the declaration above.

Notes:
- Our Flagship events - All members are asked to volunteer & help make these events great fun and a huge success for the club, therefore entries are closed to all Poole Runners members.
- England Athletics affiliation will be void if not paid on time.
- Excludes Ashdown Track Fees
- The Membership Secretary will not chase for payments, it is Members' responsibility to pay promptly.
- '100 Club' open to new and renewing members for a period of two months from 1st April to 31st May 2024.

Payment Option

• Via Bacs - Bank Account No: 21837125 Sort Code: 40-13-07 Account Name: Poole Runners

• Via Online - Credit Card Using The Poole Running Events Website (Not available for Family and 100 Club memberships)
  

BACSOnline