Beverley AC

Membership Application/Renewal Form

Year - May 1st 2008 to 30th April 2009

(If renewal and details are unchanged just complete name and payment details boxes*)

Full Name *
Address
Telephone No. Home Work
Email address
Date of Birth
Is Beverley your 1^st or 2^nd Claim Club?	1^st Claim ( ) 2^nd Claim ( ) tick to indicate
Other UKA Affiliated Clubs of which you are a member	1^st Claim ( ) 2^nd Claim ( ) tick to indicate
Previous Club (if any) and date of resignation
Do you intend to compete in UKA Races	Yes ( ) No ( ) tick to indicate

Subscriptions per year Seniors £15 - Juniors £2

Discounts (pro rata £1.25 per month) for NEW members joining late in the year and 50% discount for unwaged, full time students and retired

Prompt payment of subscriptions would be appreciated

Payment by Standing Order preferred

Payment Enclosed * Cheques payable to “Beverley AC”	£ Cheque ( ) Cash ( ) Standing order ( )
Signed *
Date *

Please give your application form and payment or post (not cash) to:-

Margaret Richardson

34 Megson Way

Walkington

HU17 8YA

Tel 01482 867233

Email margaret@broadgates.karoo.co.uk