Membership form

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Affiliated to Triathlon England

MEMBERSHIP FORM 2022

Full Name(required)

Address(required)

Gender(required)

Email(required)

DOB(required)

Emergency contact Name & Number(required)

Medical conditions(required)

Tri England Membership number

Membership Type(required)

Declarations  When you are accepted as a member of the club, the information requested above may be held on a computer file.  In addition, your basic personal details and your photo may be posted onto the Clubs website.  Should you have any objections please contact the Club Membership Secretary at membership@teamdeane.com  I confirm that to the best of my knowledge that I am able to participate in physical activity.  I understand that I am responsible for monitoring myself throughout any sessions the Club provides,  if any unusual symptoms occur I will cease participation and inform the coach and my doctor of these symptoms.  I undertake to notify the coach at once if there is any change in my condition.  I am aware that physical activity can be hazardous and there is a risk involved. I acknowledge that I participate at my own risk and take full responsibility for my actions.  I confirm that I will take every precaution possible for the safety of myself and others and act in a responsible manner.  I understand that Team Deane Triathlon Club will treat the information on this form with the strictest confidence.  I have read the Club rules and agree to abide by them (available on the website). Please Initial below to accept these terms

Electronic Signiture (required)

Membership fee can be paid to one of the committee or by bank transfer using the below account number.