Membership Form | Royal Manor of Portland AC

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Name*
Title Name Surname
Mobile Phone*
Gender*
- Male
- Female
- Prefer not to say
Date of Birth*

Day
Month
Year
Email*
Address*
Street Address Address Line 2 Town County Post Code
Emergency Contact Name*
Full name
Relationship*
Emergency Contact Mobile*
Medical Information*
Please provide any relevant medical information the club coaches would need to be made aware of.
Membership
Membership Option*
- 2022/23 EA Affiliated Membership
Affiliated Membership Cost
Price:
Affiliated Membership £25 RMPAC club membership including English Athletics Affiliation. Enables members to enter events as a RMPAC Runner with entry discounts on UKA licenced road and multi-terrain events and exclusive registered athlete offers. 'Royal Manor of Portland AC' must be used when entering your 'club name'
Membership Coupon
Declaration*
I agree to the Membership Terms & Conditions.
I confirm that I have read and fully understand the Membership Conditions and that the Rules and Regulations and Code of Practice will be adhered to at all times.
By ticking this form you are signing/agreeing to the declaration as stated above.
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Total
£ 0.00

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2023/24 Membership Form