Complete the details below and return to membership secretary

NORTH EAST VETERANS ATHLETICS CLUB.
updated 23/03/08
(Affiliated to England Athletics and North of England Athletics Association) If you are using this form to renew your NEVAC membership tick circle O

FIRST NAME(S)....................................

SURNAME...........................................
ADDRESS...........................................
..................................................
.............................POSTCODE.............
TEL.No.(incl code.................................
E MAIL ADDRESS....................................
DATE OF BIRTH.....................................
PLACE OF BIRTH....................................
Are you a member of an athletics club?............
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 date in a list of members which the Club is required to submit to Northern Athletics for levying purposes..........................................
I declare I am over 35 years of age.
* delete where applicable.
Please print and send form with cheque/order payable to " NEVAC " for £7.00 to:-
George Routledge
5 St Hildas Avenue
Holy Cross
Wallsend
Tyne & Wear
NE28 7AB
Please enclose a self stamped addressed envelope.

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 see VAANE website for further details.

SIGNATURE..........................DATE...........
Contact Secretary George Routledge at local races.