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Scarab Triathlon Club Membership Form

Please complete and return for the attention of;

Simon Clapham: 43 Norwood Road, Great Moor, Stockport, Cheshire, SK2 7JJ.

Surname................................................................

Forename .............................................................

Address..................................................................

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Postcode................................................................

Date of Birth .........................................................

Telephone (home)................................................

(Work/mobile).....................................................

E-mail address.......................................................

Profession..............................................................

Any medical conditions.......................................

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Type of membership.  junior(under 18) £15     

 (please circle)           senior £30

                                   family £45

All cheques made payable to Scarab Tri.

Signed (parent or guardian if under 18)..................................................................................

For the website:.

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Aspirations: .......................................................................................................