Membership form - new

Complete your Chichester Runners membership online

Please choose a membership option.

Individual Two People Family Junior

Your details

Title
DR MISS MR MRS MS

First Name *

Last Name *

Date of Birth *

Home Address *

City *

County *

Postcode *

Country *
UNITED KINGDOM

Home Phone Number *

Mobile Phone Number *

Email Address *

Anniversary 1 Title *

Anniversary 1 Date *

Full Membership Subscription

Tick relevant box & complete a seperate form for each person please

Full Membership (£25) Full-time Student (£20) Over 60 (£15) Under 18s Junior including EA (£30) EA Only (£15) Life Member

Associate Member Subscription

Summer Trail Runs (£15) Second Claim (£12.50)

English Athletics

Do you wish the club to (renew) register you with England Athletics (EA) for 2019/20?
Yes (Additional cost of £15 per membership)

Fill billing address from Home Address?

Billing Address *

City *

County *

Postcode *

Country *
UNITED KINGDOM

Payment Method *
Credit Card

Name on Card *

Card Number *

Card Expiry *
01 02 03 04 05 06 07 08 09 10 11 12 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Card Type *
Visa Mastercard

CCV Number *

Amount *
£