Form 1(Aug13)
BASINGSTOKE & MID HANTS ATHLETIC CLUB
MEMBERSHIP APPLICATION FORM
Website: http://www.bmhac.co.uk
Club E:mail:gensecretary@bmhac.co.uk
Membership Email:membsecretary@bmhac.co.uk
Affiliated to England Athletics Ltd, HCAA
Membership is open to all groups of the community
Club Colours: Amber/Black/Red
Life President: Reg Eade
I the undersigned hereby declare that I am an Amateur Athlete as defined by UKA Rules and wish to join the
above Athletic Club as 1st 2nd 3rd Claim member (Delete as necessary).
If you are a member of another Athletic Club please give name of Club and your membership status
1st 2nd 3rd Claim to
and your National Association Affiliation No.(where known)
I will abide by the rules and guidance of Basingstoke & Mid Hants AC(as detailed in the club Welcome Pack) and
with UKA rules. I agree to compete for the Club when selected.
SURNAME
TITLE
FIRST NAME(S)
ADDRESS
Post Code-____________________
Date of Birth
Place of Birth
Home Tel No
Mobile
E-mail address
(Please supply if possible)
Are there any health problems, which could affect training or competitive sport (e.g. asthma). Please also
inform your Coach
Name of your Coach
Please tick your main areas of interest
Track Events
Field Events
Cross Country
Road Running(18yrs+)
Coach
Official
Supporter
Signed (Prospective Member)
Signed Parent/Guardian
(if member under18 yrs)
Parent Contact Tel No. if different from above.
NOTICE TO PARENTS: The Club request your permission to use photographs that may from time to time be taken
during training or competition events. These may be used on the club website, in a club magazine or in other
promotional material. If you DISAGREE please sign below:
SIGNED
Date
………………………………………………………………………………………………………………………………………….
Notes:
All the above details are held on the Club’s computerised membership database for use in general administration only. Contact details,
age and health references may also be passed to your coach/team manager. Data is held in compliance with the Data Protection Act
1998. 1st Claim Athletes(over 10 yrs of age )/Coaches/Tech Officials/Club Officials/Helpers only: On joining the Club limited details (First
Name, Surname, Address, Date of Birth and Gender) will be passed to England Athletics Ltd in order that the Club can register you with
England Athletics . Athletes joining between April and December will then receive a Competition Licence and log in details from them.
It is recommended that you then log in to their database to check or add details and to make a decision about the use of your data. If
joining the Club between January and March you will be registered but may not receive a Licence until you have renewed your
membership the following year; This does not affect your eligibility to compete and if you need your England Membership Number
meantime you will need to contact the Club Membership Secretary (membsecretary@bmhac.co.uk). If you are moving clubs and are
already affiliated to England Athletics, the change will be picked up when you submit your Change of Eligibility form to them, please do
not forget to complete their form in addition to this membership application and then to await their response before you compete in team
competition for Basingstoke & Mid Hants AC.
When this form is completed please hand/send this application with the relevant payment (Cheques payable to B & MH AC) to
The Membership Secretary, B&MH AC, 3 Painter Pightle, Hook, Hants RG27 9SS
Please remember that, until you have completed a form, paid and the Management Committee has accepted your application you are
not eligible to compete for the Club. Membership must be renewed annually on 1st April - a reminder will be issued. Please advise the
Membership Secretary immediately of any change to your contact details.
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BMH Membership Number: __________ Date of Election: _______________ Fee Paid: £:
Card: ______