Sidmouth Running Club - Membership Form

BECOME A MEMBER

SRC Individual Membership Form

Subscription for this year covers the period from January 1st – December 31st.

Name

Date of Birth

Gender

Address

Address Line 1

City

State / Province / Region

Postal Code

Phone Number

Medical Information

Membership Payment

I confirm that I/we wish to become a Sidmouth Running Club member
I confirm that I have sent the membership payment via Bank Transfer
I have read and consent to the club policies Constitution, Health & Safety Policy, Privacy Policy.

Sort code: 40 42 02 Account Number: 61493078
Please ensure your name goes in reference box.

Phone Name Layout

Signed

Date