Senior Guest Form

Fill in this form and bring it with you on a club night to get a two week trial free of charge. Please arrive at 6pm to prepare for a 6:30 start.

The form may be filled in on a computer (preferred) or printed and filled out by hand in BLOCK capitals.

Name:	Sex:
Address:

Postcode:
Home Phone:	Mobile Phone:
Date of Birth:	Email:
Occupation:
Emergency Contact
Name:	Relation:
Phone:

A bit about you
Do you run for any other club? No Yes (Club name) :
Why are you interested in joining the club:
If you have run a 5k or 10k race in the past please give us your time
5k:	10k:
Do you take any medication? No Yes (give details) :

Please accept the following before signing

I declare that I am training at my own risk. The organisers or any other member of W&DAC will in no way be held responsible for any injury or illness incurred before, during or as a result of any of the W&DAC training methods. I also understand I must wear a high visibility vest to run on the road.

I Accept	Name/Signature:	Date:

Office Use Only
Trial start date:	Full membership due:

Wellingborough & District Athletic Club

Affiliated to England Athletics & N.A.A.

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AAC Services