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Send with cheque payable to Bexley Athletic Club for appropriate Subscription amount to :- Membership Secretary C/O 242 Rydal Drive , Bexleyheath. , Kent , DA7 5DG

Bexley Athletic Club

President: Paul Hatfield

Form of Application for Membership

Surname_____________________________________________________

Forename(s )_ _________________________________________________

Title Mr/Mrs/Ms/Miss/Master/Other__________

Date of Birth______________________Tel . No.______________________

Address______________________________________________________

_____________________________________________________________

_____________________________________________________________

NATIONALITY_________________________________________________

If previously a member of another club, state club and date of resignation.

PREVIOUS CLUB_____________________DATE RESIGNED___________

Bexley AC is affiliated to Kent County Athletic Association and South of England Athletic Association. Competition is held under UKA rules.

I HEREBY DECLARE THAT THE ABOVE PARTICULARS ARE CORRECT AND THAT I WILL ABIDE BY UK ATHLETICS RULES AND REGULATIONS FOR COMPETITORS.

Signed_____________________ Date_____________________

Parents consent signature___________________________________

(Required for athletes under 15 years)

Date of election____/____/____

President_________________________ Secretary______________