Membership renewal – Northbrook AC

Membership Renewal 2021

Renewal fees for 2021 are:

Full Rate £30.00
Second Claim £20.00
Concessionary Rate £21.00 (Full Time Student; State Pensioner or Unemployed)

These fees include the annual registration fee payable to England Athletics. Fees must be paid by 31 March to ensure continuation of your licence to enter races as an Affiliated Athlete (ie to enter races as a club runner).

Complete the form below to renew your Northbrook AC club membership.
We will email you with payment instructions when we have received your renewal submission.

To enquire about membership contact us via our Contact page.

Please note: This form is for renewing members only. If you wish to sign up as a new member you must complete a Membership Application Form.
All fields are to be completed.

First name

Last name

Date of birth

*see note below

Postal address (house no/name and street

Town/City

Post code

Email address

Preferred phone number

Membership class

Full rate £30Second Claim £20State Pensioner £21Full-Time Student £21Unemployed £21

Unique Registration Number
(This is your competition licence number on your EA Registration Card)

Next of kin, or person to contact in case of emergency
(This is optional but if not given Club accepts no liability)

Name

Phone number

Medical Declaration

I declare that I am medically fit to take part in the activities provided by Northbrook AC. I participate in the Club's activities at my own risk and agree that Northbrook AC will not be held responsible for any injury, accident, loss or damage consequential to my participation.

Personal Data

By renewing my membership I consent to my personal data provided on this form to be held by Northbrook Athletic Club and used for the purposes of club membership management and communications and, if I am a first-claim member, my name, address, telephone number and date of birth to be provided to England Athletics for competition registration and insurance purposes.

Learn more about how we process and protect personal data by reading our Privacy Policy.

When forms fields are completed select Submit once only and await response message

*some Safari versions require a date format of yyyy/mm/dd