HATCH WARREN RUNNERS (HWR) MEMBERSHIP FORM 2015 Club Subscription: £25.00 (includes England Athletics Registration Fee) Membership runs from April 01 to March 31 each year - Second claim members: £12.50 PLEASE COMPLETE AND RETURN WITH PAYMENT TO THE CLUB TREASURER (M Butler, 35 Highdowns, Hatch Warren, Basingstoke, Hants RG22 4RH) Please make cheques payable to Hatch Warren Runners Electronic Payments can be sent to Sort Code 30-90-53, Account Number 43031268 Please quote your name as the reference You may type in the details first, save it on your computer if desired then print it; don’t forget to sign at the bottom though! You may scan a signed copy of the membership form through to hwrunners@sky.com First Name(s) Last Name Date of Birth Address Postcode Telephone Number (including STD code) Mobile Number E-mail address Second claim members, who is your 1st claim club? Club Shop - please enter your club shop order below if required. eg. 1 x male vest size 40, 1 x T-Shirt size 40 We hold a limited stock at the club shop. If your garment is out of stock it will be added to our next club order. Orders are submitted as and when we have a large enough volume to do so. I certify that the information given above is correct. I have read the 2015 rules and constitution of HWR and agree to abide by them. I declare that I am an amateur as defined by the UK Athletics rules and that I will abide by these rules. I am medically fit and understand that I participate/enter in any club activities/events entirely at my own risk. I agree that Hatch Warren Runners shall not be liable for any accidents, injury, loss, damage or claim or expense that may arise in consequence of my participation in club activities/events SIGNED _____________________________________ DATE _____________________________________ HWR state that data will be maintained in accordance with the Data Protection Act and will only be used for internal purposes. It will not be disclosed to third parties.