Return completed form to Memb Sec Updated 22 Apr

NORTH EAST VETERANS ATHLETICS CLUB.
Affiliated to England Athletics and Northern Athletics ) If you are using this form to renew your NEVAC membership tick circle --> O

MR.MRS.MISS.MS*_____FIRST NAME____________________

SURNAME___________________________________________

ADDRESS___________________________________________

__________________________________________________

POSTCODE_________________

TEL.No.(+Code)____________________________________

E MAIL ADDRESS____________________________________

DATE OF BIRTH____________PLACE OF BIRTH___________

Are you a member of an athletics club?YES / NO *

If yes - name of club_____________________________

Previous Club?____________________________________

Date of resignation_______________________________
Has notification of your resignation been sent to the North of England AA ?......yes/no.*......
I do/do not* accept that my personal details will be held on a computer by the Club.........
I do/do not* agree to the disclosure of my personal data in a list of members which the Club is required to submit to Northern Athletics for levying purposes...PLEASE NOTE:-If you do not * agree to disclose your Name,Address and Date of Birth to Northern Athletics - your application cannot be considered...I declare I am over 35 years of age.
I wish to RENEW my 2013 membership and enclosed 9 pounds. tick circle -> O
I am a NEW MEMBER and enclose 9 pounds for 2013 tick circle -> O
I also wish to order a club vest and enclose a further 11 pounds. tick circle --> O
* delete where applicable.

SIGNATURE__________________________DATE___________

Please print and send this form with cheque/order payable to " NEVAC " to:-
George Routledge,5,St.Hildas Avenue,Holy Cross, Wallsend,Tyne & Wear NE28 7AB.
Please enclose a Self Stamped Addressed Envelope.
Club vests are available at £11. Please state size required.
NEVAC is a first claim Athletics Club for veterans over the age of 35.
If you wish to compete in some North East Veteran or World Masters events you may be required to join the Veteran Athletics Association-North East(VAANE).
To join VAANE you must reside or have been born in the north east area and also be a member of a club.Please contact me -George Routledge - or see VAANE website for further details.www.communigate.co.uk/ne/veteransathleticsnortheast. EMail NTMMNEVACSEC2013@hotmail.co.uk
Contact NEVAC Secretary George Routledge at local races. Please adjust form to fit one page.