Beverley AC

Membership Application/Renewal Form

Year - 1st May 2009 to 30th April 2010

(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 - If joining on or after 1st Nov then £7.50.

Also 50% reduction for unemployed, retired or full time students over 18 ( £7.50 after 1st Nov)

Note: The Club now has to pay UK:Athletics a £5 admin charge per member per year irrespective of joining date.

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