Liverpool Pembroke & Sefton Harriers & Athletics Club Local & National Athletics in UK

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Membership Form

Membership application form

Thank you for registering with the club.

"*" indicates required fields

Registration

Who are you registering for?

Myself

A child

Name

Please tell us the athlete’s name

Athletes first name Athletes surname

Your name

Please tell us your name

Relationship

What is your relationship to the child?

Parent

Grandparent

Guardian

Brother / Sister

Other

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Birthcounty*

Please state which county the athlete was born in (required for regional competition)

Birthcounty

Please state which county the athlete was born in

Email

Phone

Date of Birth*

Please tell us the athlete’s date of birth

DD slash MM slash YYYY

Other Clubs?*

Yes

No

Are you currently or have you been registered with another club?

Club

Which club are you registered with?

Competition*

Have you ever competed in athletics before?

Yes

No

Events*

What is your preferred discipline?

Track events (Running, Hurdles)

Field events (Jump, throw)

Cross Country & Road Running

Mixture

Medical

Please tell us if there are any medical conditions that our coaches need to be aware of. (ashtma, epilepsy, diabetes etc)

Emergency*

Please tell us the name of someone we should contact in an emergency

First Last

Phone*

Please provide emergency contact details

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

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