Orangegrove AC

Senior Membership Application Form

OAC Senior Membership Application

Application form for new senior members

Orangegrove AC Privacy Statement(Required)
Name(Required)
Email(Required)
Medical Consent(Required)
Please indicate any medical condition/medication that the club should be aware of

Disability

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’
Do you consider yourself to have a disability

Emergency Contact Details (ICE)

Name(Required)

Athletics

Visit our website for an overview of the membership types -http://orangegroveac.co.uk/membership/ and for full explanation of Second claim membership see UKA Rules for Competition (Rule 21) - https://www.uka.org.uk/competitions/rules/
Membership Type(Required)
Which membership type are you applying for?
Please indicate below your areas of interest i.e Track and Field Middle Distance, Marathons, Fell Racing, Cross Country etc along with any known PBs
If you have recently left another athletics club, please provide the date of your resignation. You may need to complete a Transfer of Club Membership Form -https://athleticsni.org/Clubs/Athlete-Transfers
How did you find out about Orangegrove AC?(Required)
Please indicate in the list below how you heard about Orangegrove Athletics Club

Declaration(Required)
Please type your full name to provide a digital signature