Application for Membership

Existing members should login and use the add member function to receive the discount

* required field.

“>

Surname: *
Forename: *
Gender:
value=”F”>Female
value=”M”>Male
*
Date of Birth: *

Address: *
*
Post Code: *

Tel(if over 16):

Parent/Carer Information (if under 16)

Surname:
Forename:

Tel:

Emergency Contact Information

Name: *
Relationship: *
Tel: *

Medical Conditions:

It may be essential at some time for authorised persons acting on behalf on the club to have the necessary authority to obtain urgent treatment which may be required whilst at representative club competition or training. I give my consent to emergency treatment being given to the named athlete by trained personnel:
*
Print Name: *

Area of Sport and Disciplines

“;
while ($row = mysql_fetch_array($arearesult)) {
echo ““;
}
echo ““;

$dissql = “SELECT Discipline_Code, Discipline FROM Discipline ORDER BY Discipline_Code ASC”;
$disresult = mysql_query($dissql);

echo “Discipline choice 1:”;
echo “
“;

$dis2sql = “SELECT Discipline_Code, Discipline FROM Discipline ORDER BY Discipline_Code ASC”;
$dis2result = mysql_query($dis2sql);

echo “Discipline choice 2:”;
echo ““;

$dis3sql = “SELECT Discipline_Code, Discipline FROM Discipline ORDER BY Discipline_Code ASC”;
$dis3result = mysql_query($dis3sql);

echo “Discipline choice 3:”;
echo “
“;

$dis4sql = “SELECT Discipline_Code, Discipline FROM Discipline ORDER BY Discipline_Code ASC”;
$dis4result = mysql_query($dis4sql);

echo “Discipline choice 4:”;
echo ““;

$dis5sql = “SELECT Discipline_Code, Discipline FROM Discipline ORDER BY Discipline_Code ASC”;
$dis5result = mysql_query($dis5sql);

echo “Discipline choice 5:”;
echo “
“;

?>

Volunteering for your club (a condition of your membership)

“;
while ($row = mysql_fetch_array($vr1result)) {
echo ““;
}
echo ““;
?>
*
“;
while ($row = mysql_fetch_array($vr2result)) {
echo ““;
}
echo ““;

?>

Declaration

*
value=”A”>I am not a member of an athletics club affiliated to UK/England Athletics
value=”B”>I am a member of an athletics club affiliated to UK/England Athletics, the club being: value=”C”>I was a member of an athletics club affiliated to UK/England Athletics, but ceased to be a member of:
*

Athlete Code

I am willing to abide by the club code of conduct for athletes and agree to always behave in a manner befitting an athlete:
*

Data Protection

I certify that I understand, the data provided on this form will be used solely by Leamington Cycling and Athletics club for purposes of club administration and ensuring safety. Data contained on this form which is required as part of your UK governing body registration will be shared with the relevant body. We will not disclose your data with any other external third party. Your data is stored in line with the clubs data protection policy:
*

Password: *
Acceptance Code(your coach can provide otherwise you can still submit but your application requires approval first):