Beginners Application Form


Select Title (required)


/ /

What would you like to get out of the group?

Are you currently involved in any other form/s of Exercise?
YesNo

Do you currently have any health considerations we ought to know about? (required)
YesNo

Do you suffer from any of the following?
DiabetesHeart ProblemsJoint ProblemsHigh Blood PressureAsthmaBack PainPrevious InjuryOther

The fee for the 12 week course is £16. Should you decide to become a full member on completion of the course, this amount will be discounted from the full membership fee.

Payment Method (required)

Declaration

Run England Group Leaders are qualified leaders and are willing to share their experience and enjoyment of the sport with me. I confirm that I understand that participation in this group is entirely at my own risk and should consult my own doctor if suffering from any condition that might make running injurious to my health.

By ticking this box, I confirm I have read and agree to the above declaration

Once the Form is completed and sent, please complete payment via either;

PayPal by clicking “Buy Now” button below. (You do not need a PayPal account, you can pay via PayPal using a credit or debit card).





Bank Transfer. Details are below. (Please make sure you add your name as a reference so we know who the payment is to be credited for). 

Electronic Payment Details

Account Name: Kippax Harriers

Sort Code: 40-39-21

Account No: 01101536

If you would like to pay by Cash or Cheque please arrange this with the Membership Secretary when you are contacted.

Finally, If you would like to order a Kippax Harriers Running Vest (or any other Kippax Harriers Kit) please head on over to the Kit section here to order.