Membership Form – Senior SECTION A: ATHLETE DETAILS Date of Birth Are you a member, or have you been a member, of any other Athletic Club within the last three years?NoYes If Yes, which club? Are you applying for 1st or 2nd Claim Membership? FirstSecond SECTION B: MEDICAL INFORMATION Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes, allergies, etc.) Please do not leave blank – if there is no information please write ‘None’. I consent to my personal data provided in section B to be shared with coaches for the purposes of the delivery of my safe participation in club activity. This data will not be shared or processed for any other purpose. SECTION C: EMERGENCY CONTACT DETAILS Please insert the information below to indicate the persons who should be contacted in event of an incident/accident. SECTION D: CLUB PRIVACY STATEMENT & COMMUNICATION PREFERENCES Wimborne Athletic Club take the protection of the data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current and future UK data protection legislation. Please read the full privacy notice carefully to see how The Club will treat the personal information that you provide to us. We will take reasonable care to keep your information secure and to prevent any unauthorised access. SECTION E: DATA SHARING WITH ENGLAND ATHLETICS When you become a member of or renew your membership with Wimborne Athletic Club you can also choose to be registered as a member of England Athletics (you will have to register with England Athletics if you ever compete for the club in competition Under UKA Rules). If you tick the box below we will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact email@example.com.If you do not tick the box below and then decide to compete for the club, we will need to register you with England Athletics and we will inform you at that time.I want to join England AthleticsI don’t want to join England Athletics at this timeSECTION F: ATHLETE By submitting this completed form, I confirm that I have read an understood the privacy statement and how data will be used and shared and am willing to abide by the club code of conduct for athletes.