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Surname………….. Forename………….. Gender male/female

Date of birth…./…./……

Address ………………………………..

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Telephone …………………... Mobile……………………..

Email …………………... □ Tick to receive newsletter via email

Emergency Contact: ……………………………………………

Declaration

I declare that I am an amateur according to the following definition:-

"An amateur is one who has never competed for a money prize or monetary consideration in any athletic sport or game or been in any way interested in a staked bet or wager made in connection with any athletic competition in which they were an entrant or competitor; who has never engaged in , assisted or taught any athletic exercise for pecuniary consideration, or in any way exploited their athletic ability for profit; and who has never taken part in any athletic competition with anyone who is not an amateur."

I understand that I will be registered with England Athletics, our sports national governing body, and that my details will be forwarded to them.

Signed ………………………… Dated…………………

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