Washington Running Club membership 2019/20 Membership Form 2019/20 Washington Running Club 6 month membership form 2019/20. Expires April 2020. Name* First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code PhoneEmail* DOB* Date Format: DD slash MM slash YYYY Date of BirthEmergency Contact* First Last Emergency Contact Number*What would you like to gain from Washington Running Club?* Fitness Lose weight To volunteer To improve Meet new runners Other If you selected other, please explain:Do you do any other form of exercise?*YesNoIf you selected yes, please tell us about it:Have you done any running before?*YesNoDo you have any medical or health conditions we should be aware of? Do you require medication for any of these?*Are you a recognised first aider?*YesNoIf you are, would you act as a first aider for the club?YesNoEngland Athletics*Yes pleaseNo thanksIf you intend to race as part of Washington Running Club you need to be affiliated with England Athletics. This entitles you to reduced entry fees on UKA races and some early race entries(the Blaydon Race for example). The cost for this is £15 a year or part year, and will run until 31st March 2020. If you are not registered with England Athletics you will not be able to benefit from the reduced entry fees for club runners when entering a race.Club Membership* Price: £ 11.00 Total £ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.