Beginners Application Form

    Select Title (required)


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    What would you like to get out of the group? (Please select all that apply)

    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? (Please select all that apply)
    DiabetesHeart ProblemsJoint ProblemsHigh Blood PressureAsthmaBack PainPrevious InjuryOther

    Any condition requiring medication? (required)
    YesNo

    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

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    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.