NOWRA ATHLETICS CLUB Inc. MEMBERSHIP APPLICATION

  

Club  Membership Fees include competition for Track & Field & / or Summer Road Runs, Winter XC, plus Personal & Public Liability Insurance - Oct. 2011 - Sept.2012.
 

    10yrs & under - $40           11 - 19yrs - $60       20yrs & over - $90          Life Members - $40
L A's Club Member - $30 (  LA Number must be recorded)              Family Maximum - $240

ATFCA (Non Competing) - $30          Volunteers & Pre Schoolers - No Charge           

  Age Calculated as at 30th, September this year.

  First Name Surname M/F Date of Birth Fee
***          $
***          $
***          $
***          $
***          $
***          $
Please make cheques payable to: NOWRA ATHLETICS CLUB  

Total

  $

(Age calculated as at 31st December this year)

IMPORTANT:  

To compete in State  Championship Events all Athletes must be Registered annually with Athletics NSW.  

The above fees do not fully cover these Registration costs.  For several years our club has been paying the additional fees for members who wish to make a commitment to  compete in State Championship Events. 

For this reason we require  ALL MEMBERS to indicate their intentions in the  *** areas above, as follows :  

 

Place 1  if  you intend to compete only in local Club Events  i.e.  T & F /  Summer Road Runs / Winter Events.

 

Place 2  if you intend to compete in the  Country T & F Championships   (Venue, January 2012 - Newcastle  )

 

Place 3  if you intend to compete in Country & State T & F  Championships  &  State  Winter  Championships  

 

Place 4  if you intend competing for club during Summer  but wish to enter    State  Winter  Championships  

 
 New Members who are unsure  - Please discuss with club officials for guidance.

 
ADDRESS: …………………………………………………………………………………  POSTCODE:  ………..............

HOME PHONE: …………………………….……….…  MOBILE / WORK PHONE: ……………………………............
 * EMAIL (print clearly):  ………………………………………………………………………………...............................

 

       Please  Only include your * EMAIL address if you wish to use this method for receiving  information . 

.     Does the Club have  permission to take  photos / videos of you or family members during competition ?                                                   Please circle:    YES   /  NO     Signed  ……………………...............................

Date:                       Total Amount Paid:                                              Date:                          Part Pay Amount:

Date:                         Part Pay Amount:                                              Date:                          Part Pay Amount: