ABERGELE         HARRIERS

(affiliated to the AAW)

Membership Application 2009 - 2010

I acknowledge that my personal details will be held on a Database by the Club Officers.

I agree to this data (name, address, home phone, mobile phone, email address) being made available to other Members via written requests from members to the membership secretary (please indicate): Yes/No

I understand it is purely for the purpose of keeping in touch with other

Members.

SURNAME: ………………….…………………………… FIRST NAME(s): …………………………………………………………..…

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

………………………………………………………………………………………………………………………………………………………………………….

POST CODE: ………………………………….…

Date of Birth: …………../…………..…………../ 19…………..………            Place of Birth …………………….

Male/Female

 Home Tel: ……..……/…………………. Mobile Tel: ……………/…………………..

Email: …………………………………….……………………………………………………………………………………………………………………

In Emergency Contact Phone Number(s): ……..……/…………………………………...

 Name of Contact: …………………………

Membership required (please indicate):

• New Membership - please indicate which vest size  s m l xl xxl                
• Renewal Membership
• Second Claim/Social Member

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For second claim members, please give details of first claim club and AAW number: