Waveney Valley AC - Road Running Membership Form [Caldera]

New Member Renewal

Title

First Name

Last Name

Gender

Male Female

Address

Town

County

Postcode

Telephone

Mobile

If no landline number, enter mobile number instead in Telephone field

Date of Birth (dd/mm/yyyy)

County of Birth

Emergency Contact Name

Emergency Contact Telephone

First claim UKA affiliated club if not WVAC

I hereby apply for membership of Waveney Valley Athletic Club and agree to abide by the Club’s rules and codes of conduct as displayed on www.waveneyvalley.org and I further agree to abide by the rules of the Governing Body of Athletics.
If these should be breached I understand that I may be asked to leave the club. I agree that I am an amateur as defined by the Governing Body of Athletics. I am, as far as I am aware fit, to take part in strenuous physical activity.

Signed (applicant)

WVAC MEMBERSHIP UNTIL 31ST MARCH 2022

Covers UKA affiliation only :-£15

Membership will revert to previous £32 per member (with family discounts) for 2022–23

~~Price for 1 Member (with UKA Fees) £30~~

~~Price for 3 Members (with UKA Fees) £76~~

~~Price for 2 Members (with UKA Fees) £54~~

~~Price for 4 Members (with UKA Fees) £98~~

The above membership fees includes a £15 UK Affiliation payment per person which Waveney Valley Athletic Club will forward on your behalf.

Method of Payment (*tick as appropriate)

Online via England Athletics Bank Transfer Cash

Date:

If paying by Bank Transfer please use details below.

Waveney Valley Athletic Club, Santander.
Sort Code: 09-01-29, Account No: 21206227

Please give your name as the reference so we know who the payment is from.

Your details will be stored on a computer database and used in connection with business relating to WVAC and the necessary Athletic Governing Bodies.