Membership Form

Fill in the form below to become a member of the Kuhac Road Runners club. If you have any questions please contact us.

You can either pay with Paypal when you complete the form, or click to pay in person.

Athlete Details

Title*

First Name*

Last Name*

Address 1*

Address 2*

Town*

Postcode*

Telephone*

Email*

Date of Birth*

England Athletic Registration No. (if a member)

Fees and Subscriptions

Membership Type*

Add optional England Athletics Membership / NCAA Registration - £21 – This reduces your entry fee to all UKA organised races by £2.

New Members joining in December / January pay half annual rate.
If joining in February the full membership rate will be paid but this will be carried over into the following year.
All Subscriptions are due on March 1st

Medical Information

Please indicate any important medical / disability information (eg epilepsy, asthma, diabetes, allergies etc.)

Emergency Consent & Contact

Please indicate the person(s) who should be contacted in the event of an incident or emergency

Contact 1 Name*

Contact 1 Telephone*

Contact 2 Name

Contact 2 Telephone

Athlete Agreement

I give consent for emergency treatment to be administered by persons acting on behalf of the club whilst at representative club competition or training.*

I give consent for the club to hold my personal data in accordance to the Club’s Data Protection document here*

I agree to abide by the Club’s Code of Conduct for athletes and agree to behave in the manner befitting a KUHAC Athlete during club events.*

KUHAC Membership Form

Athlete Details

Fees and Subscriptions

Medical Information

Emergency Consent & Contact

Athlete Agreement