Leeds City Athletic Club, John Charles Centre for Sport, Middleton Grove, Leeds, LS11 5DJ

LEEDS CITY ATHLETIC CLUB MEMBERSHIP APPLICATIONS

FOR BOTH NEW MEMBERS & RENEWALS

Leeds City Athletic Club welcomes all applications for membership, irrespective of age (provided the applicant is 8+), gender, disability, race, ethnicity, religion and political view. Please complete the application to the best of your ability and knowledge. Any false information may invalidate your application and mistakes may result in delays.

Please note that costs for joining Leeds City Athletic Club include;an annual membership fee plus an annual or monthly fee (payable over 12 months) for training night subs.

For membership queries please contact the club on 0113 2403195

    Member details

    This application is :
    First Name(s)*
    Surname*
    Mobile tel*
    Home tel
    Email*
    DOB*
    Gender*

    Address line 1*
    Address line 2
    County*
    Postcode*

    Membership status

    Application for:

    Age groups at 31st August / 1st September

    (i.e. Age 13 at 31/08 = Under 15; Age 13 at 01/09 = Under 13 athlete)

    *Prices for new members include one club vest. A family membership receives one club vest per family. The above prices include the compulsory annual registration to England Athletics (Current price is £15 per year) and annual levy to Northern Athletics (price is usually £2 per year, for 2021/22 this is subsidised by the club) which Leeds City Athletics Club will register on your behalf.

    Age groups at 31st August / 1st September

    (i.e. Age 13 at 31/08 = Under 15; Age 13 at 01/09 = Under 13 athlete)

    *Prices for new members include one club vest. A family membership receives one club vest per family. The above prices include the compulsory annual registration to England Athletics (Current price is £15 per year) and annual levy to Northern Athletics (price is usually £2 per year, for 2021/22 this is subsidised by the club) which Leeds City Athletics Club will register on your behalf.

    Training Night Subs

    Please note that training night subs are payable in addition to your annual membership fee. If you choose to pay monthly, your first monthly payment is due immediately followed by a Standing Order from 1st day of the following/next month. If you wish to train on club nights please select if you want to pay your training night subs annually or monthly?

    Monthly subs are as follows - please select:
    Yearly subs are as follows - please select:

    Membership of other clubs

    Are you or have you been a member of another Athletics Club?

    Please provide details of the club:

    Clubs name
    Clubs EA Number
    Have you paid the EA&NA Fee this year?

    (Please note: As you have already paid your EA&NA fees please deduct £15 & £0 from payment)

    Have you resigned from your previous club membership?

    What date did you resign?
    Are you applying to LCAC for 1st or 2nd claim membership?
    Are you applying for Higher Competition club membership? (i.e. Competing for LCAC if your 1stclaim club enters competition at a lower level)

    Disability

    The Disability Discrimination Act 1995 defines a disabled person as anyone with “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”.

    Are you registered disabled?
    What is the nature of your disability?

    Competition Details

    Please tick all applicable:

    What is your nominated county for competition?
    Are you a qualified Coach?

    Please provide coaching qualifications:

    Level
    Coaching Ref. No.
    Disclosure & Barring Letter (acceptable formats: jpg, pdf, doc, docx, odt)
    Are you a graded Technical Official?

    Please provide details of your Technical Grade:

    Are you willing to volunteer in any way to help the club?

    Declaration

    PLEASE NOTE -for a young athlete under 16 the signature of a parent/carer is required.


    • I agree to take part in competitive athletics
    • I agree to be bound by the Leeds City Athletic Club rules as set out in the club constitution or in the code of conduct - Read here (opens new window)
    • I confirm that I am eligible to compete under UK Athletics rules

    GDPR

    • I understand that my personal data will be held securely by the club
    • Authorised photographers may be used by the club to take pictures of LCAC members taking part in events for publicity and promotional purposes (e.g. club newsletters/LCAC website/local newspaper)
    • When you become a member of Leeds City Athletics Club you will automatically be registered as a member of England Athletics. We will provide England Athletics with your personal data which they will be able to use to enable access to an online portal for you (My Athletics). England Athletics will contact you to invite you to sign into and update your My Athletics portal, which amongst other things, allows you to set and amend your privacy settings. If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact dataprotection@englandathletics.org.
    Name of Parent/Guardian:
    Relationship to the Child:
    Parent/Guardian Signature: (Typed accepted)
    Date:
    Signature of applicant*: (Typed accepted)
    Date:

    ENGLAND ATHLETICS REGISTRATION

    In order to compete as an athlete you must be registered with England Athletics. By completing and returning this form, along with your payment, Leeds City Athletics Club will process your registration on your behalf with England Athletics. Once registered, England Athletics will provide you with a unique registration number. This then enables you to compete. Your unique registration number must be quoted on all entry forms/lists alongside your name.

    NORTHERN ATHLETICS LEVY

    Northern Athletics provide athletes with competition in the North of England. Due to funding cuts, a £2 levy per competing athlete has been agreed between Northern Athletics and the clubs per year. For 2021/22 Leeds City will cover this cost on behalf of every athlete. By completing and returning this form along with your payment Leeds City Athletics Club will process your registration on your behalf with Northern Athletics.

    IMPORTANT INFORMATION - PLEASE READ BEFORE SUBMITTING THIS FORM

    Once you have submitted this form you will receive a request for payment for membership and any training night subs via email from 'noreply@englandathletics.org'. Please check spam if you do not receive this in a few days.

    Applications will not be completed without payment. Failure to pay the correct fee and/or submit the correct forms may impact on the athlete being able to compete or train.