Utopia Triathlon Club

Application form

Mr/Mrs/Miss/Ms

 

First Name:

 

Address:

 

 

Post Code:

 

Tel (home):

Surname:

Emergency Contact:

Exclusion from Liability

Neither club officers nor members will be liable to any member or guest for injury, loss or damage to property, although appropriate insurance will be taken out.

Membership Fee

  

I hereby enclose the membership fee of £ 12.00

Payable to Utopia Triathlon Club

 

Signature_____________________________

 

Date _______________
 

Please return to: Membership Secretary, Utopia Triathlon Club, Utopia Leisure Centre, Downsview Crescent, UCKFIELD, TN22 1UB

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