Mickleover Running Club

PRE CLUB RUN
REGISTRATION

Coming to a club run for the first time? Fill out this little form so you dont need to on night.

Please email our Membership Secretary Paul directly using the email address membership@mickleoverrunningclub.co.uk. Sorry for any inconvenience.

First name

Last name

E-mail

Phone

Date of Birth

Gender

Address

First Line of Address

City

Postcode

Do you have any medical conditions? If so please state

Emergency Contact First Name

Emergency Contact Surname

Relationship to emergency contact

Emergency contact phone number

Click below for our online membership form and join our friendly local running club