Membership Form
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Name:
Address:
Post Code:
Home Tel: Work Tel:
Mobile Tel: E-Mail:
Date Of Birth: Club

Male
Female
Membership Category:
Free Vest or T-Shirt
Size

Athletes: Please Give Details
Distance Time Date Venue
800m
1500m
3000m
5000m

Your Coach's Name
Your Coach's Tel No
Your Coach's E-mail

Coaches: Please Give Details:
Qualifications Awarding Body No Years Coaching

Associates: Please Give Details
Athlete
Parent
Teacher
Other

This form should be printed. Then return the completed application form and cheque to:
BMC Treasurer, Pat Fitzgerald, 47 Station Road, UXBRIDGE, UB8 3AB
Please enclose an A4 stamped self addressed envelope and a cheque for 30 (35 overseas).
Cheques should be made payable to BMC