Membership Application

    Personal Details

    Name *
    Address incl. Postcode *
    Home telephone *
    Mobile telephone *
    Email *
    Date of birth *
    Gender * MaleFemale
    Do you consider yourself to have a disability? * YesNo
    If yes, what is the nature of your disability?

    Medical Information

    Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes, etc.) *

    Emergency Contact Details

    The name & number of person(s) who should be contacted in case of an incident/accident
    1st contact
    Name & number *
    2nd contact
    Name & number *

    Sporting Information

    Why do you want to join Yate Tri-stars? *
    Have you participated in triathlon before? * YesNo
    If Yes can you give brief details
    Do you already participate in? RunningSwimmingCycling
    Do you belong to any sports clubs? * YesNo
    Please give details of any other sports information, including existing club memberships
    Do you have swim times for any of these distances? 50m Do you have run times for any of these distances? 400m
    100m 600m
    200m 800m
    300m 1500m
    400m 5000m

    Parent or Guardian Consent Information

    I confirm that I have read, or been made aware of, the club’s policies concerning: *


    (These can be found in the Club Handbook
    on the resources page)

    Name of parent/guardian *
    Application date *

    * = required information

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