Please complete our membership application form below. Fields marked with an * are mandatory.
What's your First Name? *
What's your Middle Name(s)?
What's your Surname? *
What's your Date of Birth? *
Email address *
This is so that we can send you our newsletters and important updates.
Your mobile number *
We’ll use this to let you know if any runs need to be cancelled.
And what’s your postal address? Line 1 *
When you become a member of or renew your membership with Benson Striders you can also choose to be registered as a member of England Athletics (you will have to register with England Athletics if you ever compete for the club in competition Under UKA Rules). If you choose to affiliate with England Athletics we will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact firstname.lastname@example.org.
If you do not affiliate with England Athletics and then decide to compete for the club, we will need to register you with England Athletics and we will inform you at that time.
Do you want to affiliate with England Athletics? * Please select: ---Membership without EA Affiliation - £20.00Membership with EA Affiliation - £35.00
Our membership fee is due on or before 1st April. You can have 1 free taster sessions before you decide to join. We'll discuss what this includes when we see you.
Payment should be made to: Benson Striders Running Club Account: 19660960 Sort Code: 30-99-63 Reference: subs/year/your name e.g. subs2016PeterJones
Sorry NO membership NO running with the groups (unless you are on your trial session).
All members are provided witb an ICE (in case of emergency) Tag which stores emergency information. The bar code is also used to record your attendance and this information will only be used by the club. We will not share your details with anyone else.
We like to keep all our members safe, just in case of an emergency, therefore we ask you to provide two emergency contact details.
Please note that your Emergency contacts will be stored on your ICE tag
1st Emergency Contact Name e.g Fred Bloggs *
1st Emergency Contact Phone Number *
2nd Emergency Contact Name *
2nd Emergency Contact Phone Number *
This information will be temporarily stored on our database and will only be used for your own welfare and to produce your ICE Tag.
Please only answer with Medical Information here that you wish to appear on the tag.
Do you have any other health considerations/previous injuries we should know about, or any condition requiring medication? ---NoYes
If Yes, please provide details
Have you done any running before? * ---NoYes
For Women: Are you current pregnant/breastfeeding or had a baby in the last 6 months? ---NoYes
I hereby confirm that I participate in Benson Striders running groups completely at my own risk and state that I do not hold Benson Striders or any of its representatives responsible for any injury, loss or accident incurred.
I accept that I will be running on the highways, pavements and roads and agree to take full responsibility for following the Highway Code when running.
I agree to provide my own reflective vest, armband or similar high visibility clothing, and/or head torch to make me visible, and wear it when running at night or when advised.
I agree that I know not of any medical or physical reason why I should not participate in Benson Striders and if under supervision from my doctor that I have permission from my doctor to allow me to participate. If I am unsure of my suitability to participate I will gain permission from my doctor. If I develop any new relevant medical or physical condition, I will inform Benson Striders.
I understand that my personal details will be held on computer by the club solely for the purposes of club administration, management and communication. An appropriate third party will be used to print the ICE Tags. If I choose to affiliate to England Athletics my details will be passed onto England Athletics. Competition providers may be passed a copy of the data necessary for their event.
I will abide by the Benson Striders Code of Conduct *
---I acceptI do not accept
Benson Striders wish to use photos taken from time to time to share on facebook, the website, newsletters, promotional material and other media.
Please select NO, here if you DON'T wish photos of you to be shared. *---YesNo
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