NAME: Surname ...................................................................

First Name: .........................................................................

ADDRESS: ...............................................................................................

....................................................................................................................

....................................................................................................................

PHONE No: (0 ........) .........................

DATE OF BIRTH: .................................

SEX: M / F (Circle One)

I wish to join/renew my membership of the Hawke's Bay Marathon Clinic. I agree to abide by the rules as stated in the Club's Constitution. I also agree that in the terms of the Privacy Act my personal details as listed above only may be made available for promotional purposes by the Hawke's Bay Marathon Clinic or any other organisation as deemed necessary by the Executive. I indemnify the Hawke's Bay Marathon Clinic from any responsibility in the event of my injury or death resulting from attendance or participation in any meeting, training or other event organised by or on behalf of The Hawke's Bay Marathon Clinic.

SIGNATURE OF APPLICANT: ................................................................................................

The following fees, having been set by the Annual General Meeting of the Hawke's bay Marathon Clinic are applicable until changed.

HAWKE'S BAY MARATHON CLINIC MEMBERSHIP

15.00

To NAPIER or HASTINGS BRANCH (Delete One)

Add:-

ADDITIONAL FAMILY MEMBERSHIP WHERE APPLICABLE

10.00

(Refer to the conditions for Family membership)noted below)

To NAPIER or HASTINGS BRANCH (Delete One)

Add:-

ATHLETICS NEW ZEALAND MEMBERSHIP FEE

10.00

Or:- As I am a member of Athletics New Zealand with .......................................................................................................... (Name of Club)

and/or being a child under the age of 15 years as at the 1st january of this year, I have deleted the ANZ Fee of $10.00.

TOTAL AMOUNT ENCLOSED:

$........... .00

FAMILY MEMBERSHIP is available to a Member and their legal partner as defined by New Zealand Law and shall include any children under the age of 15 years as at the 1st January in the applicable financial year and permanently in residence at the same address as the Member. Such children shall automatically be deemed to be financial members of Athletics New Zealand. A separate 'Application for Membership form must be filled out for each family member and must accompany the form which includes the 'Membership Fees due.