Northbrook Athletic Club - Membership Form

Northbrook welcomes new runners of all ages and abilities, from beginners to experienced athletes, both male and female. We are based at Jaguar Sports & Social Club on Browns Lane, Coventry, and meet on Wednesday evenings at 7:15pm and Sunday mornings around 10:00am (Enquire first). Whether you wish to compete in races, or just run for fun to keep fit, why not come along to the club or send this form to:
Membership Secretary: Tony French, 66 Brackenhurst Road, Coundon, Coventry. CV6 2DR

Tel: 024 7633 3594

E-mail: frenchat2002@yahoo.co.uk

Current Fees: 1st claim: £15.00/year, 2nd claim: £7.50/year, (Jaguar Club fees extra)
Concessions are available for juniors, students, unemployed, & OAP's. Please enquire about these.

Please make cheques payable to: Northbrook AC

Visit our website for more information at: www.northbrookac.org.uk

Application to Join

Full name:
Address: Postcode:
Telephone Number - Home: Mobile:
E-mail Address:
Date of Birth:	Gender: Male/Female
County of Birth: Note: Counties are defined as pre 1974 boundaries (i.e. Warwickshire includes Coventry, Solihull and Birmingham).
If resident in Warwickshire (as defined above), have you had continuous bona fide residency for, at least, nine months. If not, state date of moving into the County.		Y/N
Have you ever been a Northbrook member in the past? If Yes please state last year as member		Y/N
Are you, or have you ever been, a member of another club? If Yes is Northbrook your 1st or 2nd claim? (If unsure of definition, please enquire)		Y/N
How did you hear of the club
I apply to become a member of Northbrook Athletic Club. If elected, I will abide by the Club rules. I hereby declare that I am an amateur, as defined by the Rules of the Governing Body of athletics. Signature: Date: