You must have JavaScript enabled to use this form (see your browser preferences). You can carry on, but you will have to write the amounts and the total in the space. Please provide the details of 2nd and subsequent family members, if any, on the bottom of the paper in the same format.

Membership Application and Renewal Form Submission of this application form and associated fee provides membership for 1 year Membership is renewable annually on 31 March

Steps to take for application

1. Select your membership type. (Under 21 - individual membership for under 21s only; Couple - 2 adults living at same address; Family - 1 or 2 adults plus children under age of 18 years or until further education has been completed.)

2. Specify the number of people requiring UKA registration. You must have UKA registration to compete in events.

3. Enter your contact address.

4. Enter your personal details in the boxes - start with the main family contact.

5. Select the Add Another Member button to add additional members. Add their details.

6. Select the Review button to review your details.

7. When you are happy we recommend that you save or print a copy of the review page for your own records.

8. If you wish to pay by cheque then print the form, sign and post it with your payment to Kevin Ashman, 4 Peters Close, Locks Heath, Southampton SO31 6ED.
    Cheques should be made payable to Stubbington Green Runners.

9. If you wish to pay by credit card then select the PayPal Payment button.
    NOTE FOR PAYPAL USERS: Before paying ensure that you agree with the declaration on the payment page.
    Payment by PayPal confirms that you are in agreement with this statement and acts as a signature.

NOTE: Once you have started entering your details do NOT use the Back button above. Only use the buttons provided to review details.

Application Details

		Amount £
Membership type:	Select membership type... Individual under 21 membership £10 Individual membership £16 Couple membership £22 Family membership £28 (see below for UKA)
How many family members need UKA registration?
Total amount payable
Address details - Only one home address per family please
Line 1
Line 2
Line 3
Postcode

Member Details

Fill in the details below and use the button to add extra members. If you add too many, just leave the name boxes empty.
The first member listed should be the main contact and must declare an email address if paying over the Internet.

No.	Surname	Forename	Male / Female	UKA Req'd?	UKA number (if available)	Date of Birth DD/MM/YY	If member of another UKA club, insert name	Is other club first claim?
	Home Tel No	Work Tel No	Mobile Tel No	Email			Newsletter preference	Nationality
	Personal Best Times since June 2007:		10k		5 miles	10 miles	Half Marathon	Marathon

Add Another Member

Do NOT print this page. Click the Review button to check that you are happy with your details.

Review

These Membership Application pages have been implemented by Caroline Street. If you have a similar requirement for your site then please