Indicates required field
First Name:
Surname: Address:
Surname: Address: Email: Date of Birth:
Date of Birth: Home Phone: Mobile: Sex:
Mobile: Sex: Do you wished to be emailed on: General Club Information Club Events
General Club Information Club EventsPreferred method of contact: email
Have you previously belonged to the Marathon Club of Guernsey?
Have you previously belonged to a Marathon Club?
If yes, please state the name of the Club:
Do you run regularly? If yes, how far? and how often?
If yes, how far? and how often?Do you exercise in other ways? If yes, in what way?
If yes, in what way?Have you run a Marathon before? If yes, where and what is your fastest finish time?
Are you interested in running a Marathon?
Subcriptions: Club fees are £50.00 for a period of twelve months from the date that the application is received.
Marathon Club of Guernsey fee explanation:
These fees are the portion of all registered fees that go towards the overall administration of the Marathon Club of Guernsey and this levy assists in the funding of our sport at a local level.
Total fee payable:
Fees may be paid by cash/cheque or direct debit:
Account details:
Please use name as reference.
Payment and registrations forms can also be posted to the Marathon Club of Guernsey,
Privacy Act:
I consent to the information supplied on this form being incorporated into the Club’s register and for it to be available to Club Members to contact each other on Marathon Club related matters.
Medical:
The Club accepts no responsibility for any injury suffered whilst (1) taking part in any Club activity or (2) being on grounds and premises controlled by the Club. Members give the Club permission to seek medical attention if any sickness or injury occurs while at the Club.
Please answer the below questions regarding any medical conditions that the Club should be aware of (Please circle the relevant answer):
Are you under the care of a doctor for any reason?
Are you taking any form of medication?
If yes, please specify:
Do you have a history of heart trouble?
Has any family member under the age of 50 suffered with heart disease?
Do you suffer from pains in your chest, dizziness or fainting?
Do you have high blood pressure?
Do you smoke?
If yes, please specify an average number per day:
Do you suffer from asthma, diabetes or epilepsy?
Do you suffer any problems with your back, knees or other?
If yes, please specify:
Please specify if there is any significant medical information that has not been mentioned above:
Declaration:
I acknowledge that I have not withheld any relevant information relating to my present health status and that the Marathon Club of Guernsey will take every possible care to ensure my safety, accepting that I exercise within the guidelines they give and at my own risk. I have read and understood all of the above and agree to abide to the rules of the Marathon Club of Guernsey.
Marathon Club of Guernsey Registration Form 2009/2010
Membership of the Club is available to anybody over the age of seventeen. The subscription is £50 per calendar year, that is, twelve months from the date of application acceptance. An Application Form is attached CLICK HERE
for a printable version or complete the form below
We would be delighted to welcome you as a member and enjoy the benefits that running provides – health, fitness, wellbeing and team spirit.
“ Never put limits on yourself – for we never know our limits until we exceed them “
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Web site designed and hosted by Bo-Style.com 01481 711133
