BENDIGO YMCA HARRIERS

CLUB REGISTRATION FORM - 2010
FAMILY MEMBERS:                       D.O.B:                                  EMAIL: (If different to mail contact)
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ADDRESS: __________________________________________________________________________
PHONE: _________________________ MOBILE:___________________________
Fill in the email address details to receive newsletters, write up’s, competition info and general club info.

EMAIL : ________________________________________________________________
          Non AV      AV reg
             Club Membership Types: Open Age (includes Veterans)      $30  []      $20   []
              Juniors (Under 20 and below)                                             $15  []      $10   []
              Family Membership                                                            $60  []      $50   []
             Social Membership                                                             $20  []     

NOTE: Family discount of $10/member who is AV registered. Minimum payment of  $20.

Athletics Victoria Fees:Open Age (includes Veterans)            $120 []
U 18 - U 20 (as at 31/12/10)                                                $100 []
U 14 - U 16 (as at 31/12/10)                                                $80   []
Officials                                                                                $40   []
Associate                                                                              $40   []
(These prices include Country Athlete discount)
Please note that some discounts apply for coaches, officials and athletes associated with Little Athletics

Please remember that you must be AV registered in order to compete in:
- Athletics Bendigo Track and Field Championships
- Athletics Bendigo Relays
- Grand Prix Events
- Memorial races (Ern Hammer 3000m, Richard Kitt 1500m and Sally Conroy 200m)
- Athletics Victoria Cross Country Events
- Victorian Country Championships
- State Championships

To ensure your safety when competing, the club needs to be aware of any allergies or medications that could become issues.
ALLERGIES: _________________________________________________________
MEDICATIONS: ______________________________________________________