Membership Form - Pontypridd Roadents AC

Name *

First

Last

Date of Birth *

Gender

Address *

Email *

Telephone Number *

Emergency Contact Name *

First

Last

Emergency Contact Address *

Emergency Telephone Number *

Membership Choice *

Senior Membership inc Welsh Athletics (Aged 20yrs and over) £45
Junior Membership inc Welsh Athletics (Aged 17-19yrs old) £35
2nd claim / Associate Membership (Affiliated to other club) £24.00

Are you affiliated to another club? *

If YES please state which club

Current Registration number, if applicable

HEALTH DECLARATION: Do you have any health considerations we should know about? If YES, please give more information below *

Health Considerations (if YES)

DISCLAIMER: I confirm that to the best of my knowledge I can participate in physical activity. I confirm that I understand that participation in this club is entirely at my own risk and I should consult my doctor if suffering from any condition that might make running injurious to my health. If I am required to seek my doctor’s advice prior to commencement of any physical activity, I agree to contact my doctor and I take full responsibility for obtaining written permission before starting such activities. I understand that I am responsible for monitoring myself throughout the training sessions and that if any unusual symptoms occur, I will cease participation and inform the group leader and my doctor. I confirm that I will take every precaution possible for the safety of myself and others and act in a responsible manner. I am aware that physical activity can be hazardous and there is a risk involved. I acknowledge that I participate at my own risk and take full responsibility for my actions. I understand that I cannot hold the club or its officers liable for any loss of injury, however caused. *

DECLARATION: In submitting this form, I confirm that I have read, understood and agree to abide by the rules contained in the Club’s Policies to include, but not limited to: - Club Constitution - Code of Conduct Policy - Social Media Policy. I hereby apply to become a member of Pontypridd Roadents A.C. and confirm that I am an amateur as defined by Welsh Athletics Ltd. (By becoming a member of the club, you are automatically agreeing to the codes of practice as stated by Welsh Athletics – this relates to the codes of conduct, to the rules of UK Athletics and to adhere to all anti-doping rules and regulations) *

DATA PROTECTION: When you become a member of, or renew your membership with, Pontypridd Roadents A.C you will automatically be registered as a member of Welsh Athletics. We will provide Welsh Athletics with your personal data and you will have access to this information via the online portal myATHLETICS. In addition to passing data to Welsh Athletics, the use of data is likely to include the following activities, and more: Team selection and competition entry, Membership and club management, Marketing and club communications, Funding and reporting purposes. This data will be held securely and will not be passed to anyone other than you, and any other club member with a need to access it for the club’s purposes. The information held will be deleted when you cease to be a club member. Under no circumstances will the data be passed to any other person or third party (except for Welsh Athletics) unless specific consent in obtained. Please tick the boxes below to indicate your consent. *

I consent to the club recording my race results and using any photographs, including my image taken at club activities and races, for publicity and to promote the club.
I consent to Pontypridd Roadents A.C. collecting and storing my personal data for the purposes stated above