MICKLEOVER RUNNING CLUB B2R COURSE

Your Data

This data is used to facilitate the administration and club communication and is NOT shared with third parties.

Information (ie medical notes) are shared where it is deemed necessary with the Run Leaders so as to ensure your Health and Safety on Club Runs.

Periodically we will use third party mailing tools such as mailchimp to send out emails.

This is a secure service however if you wish to review their privacy statement you can do so: Click Here

Member Details
PLEASE NOTE: YOU MUST BE OVER 18

First name

Last name

E-mail

Phone

Date of Birth

Gender Please Select Male Female

Address

First Line of Address

City

Postcode

Do you have any medical conditions? If so please state

Are you taking any medication? If so please state

Emergency Contact information

Emergency Contact First Name

Emergency Contact Surname

Relationship to emergency contact

Emergency contact phone number

Social Media

I am happy for my images to be used by Mickleover Running Club on the following social media websites:

I agree to Mickleover Running Club using my image on Facebook

I agree to Mickleover Running Club using my image on Instagram

Website

I am happy for my images to be used on the Mickleover Running Club Website (www.mickleoverrunningclub.co.uk):

I agree to Mickleover Running Club using my image on their Offical Website

DECLARATION

By submitting this form I agree to abide by the rules as laid down in the club constitution and confirm that I am eligible to compete under England Athletics Rules. :

I agree to abide by the rules as laid down in the club constitution and confirm that I am eligible to compete under England Athletics Rules.

Code of Conduct

Agreement to Mickleover Running Club's Code Of Conduct which can be found here:

I agree to Mickleover Running Club's Code Of Conduct.

SUBMIT TO MRC b2r team

PROCEED TO STEP 02/02

PAYMENT