Road Running Membership Form Url Application Type New Member Renewal Title * Mr Mrs Miss Ms Mx (gender-netural) Dr Other Cllr Sir First Name * Last Name * Gender * Male Female Address * Address Town * County * Postcode * Telephone * Mobile If no landline number, enter mobile number instead in Telephone field Email * 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.