EAST ANTRIM RAMBLING CLUB - MEMBERSHIP APPLICATION (REVISED 25/6/21)

Type of Membership Required (please tick):	Single Person (£25 annually)		Family Couple (£40 annually)
Name (1^st Applicant) (App)
Name (2^nd Applicant) (App)
Address & Postcode:
Telephone (1^st App)	Home:	Mobile:
Telephone (2^nd App)	Home:	Mobile:
E Mail Address: (1^st App)
E Mail Address: (2^nd App)

PAYMENT OF SUBSCRIPTIONS: Payment can be made in one of the following ways:

(1) Cheque made payable to East Antrim Rambling Club and passed to the Treasurer,

(2) Cash payable to the Treasurer and

(3) On-line Transfer (the club’s bank details are as follows: Sort Code: 09-01-29 and Account Number: 00584559.

CLUB TREASURER

Alastair Jack, 12 Glencroft Road, Newtownabbey BT36 5GD.

Tel: O2890 835956

Mobile: 07597 995290.

Email: alastrjack@aol.com

Grateful if you would advise how you heard about our Club? ............................................................................................................................................................

Grateful if you would advise what made you want to join our Club? ............................................................................................................................................................

............................................................................................................................................................

The following additional information is required by Sport NI (in confidence) to enable monitoring under Sport NI’s Active Clubs Programme.

1^ST APPLICANT

Male / Female……………………………… Ethnic Origin……………………………………….

Age Range, (please circle) Under 18, 18-25, 26-40, 41-59, 60+

Do you consider yourself to be disabled? (Please circle) Yes No

If yes could you expand on this? (Please circle), Mobility Issues, Learning Disability, Hearing, Visual Impairment.

(PTO)

2^nd APPLICANT

Male / Female……………………………… Ethnic Origin……………………………………….

Age Range, please circle, Under 18, 18-25, 26-40, 41-59, 60+

Do you consider yourself to be disabled? (Please circle) Yes No

If yes could you expand on this? (Please circle), Mobility Issues, Learning Disability, Hearing, Visual Impairment.

PLEASE PASS YOUR COMPLETED APPLICATION TO THE CLUB SECRETARY (Teresa Malone) AFTER YOU HAVE MADE PAYMENT TO THE TREASURER.

PLEASE FAMILIARISE YOURSELF WITH THE CLUB’S WALK PARTICIPATION CONDITIONS / CODE FOR WALKERS WHICH CAN BE LOCATED ON THE CLUB’S INTERNET HOME PAGE (www.earc.org.uk)

1st Applicant

Signature…………………………………………………………………………………………Date………………………….

2^nd Applicant

Signature…………………………………………………………………………………………Date………………………….

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