Membership Registration Form 2020

Name*

First Last

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Email*

Phone (Home)

Phone (Mobile)

Consent

I consent for photos of me at WHC events to be published on the club website and social media pages, or to be used for WHC marketing purposes.

2020-2021 Grades and Fees Schedule

Membership*

Wanganui Harrier Club Walker/Runner Adult (20 years +) - $20
Wanganui Harrier Club Walker/Runner Child (up to 20 years) - $10
Wanganui Harrier Club Walker/Runner Family (up to 2 Adults and up to 4 Children) - $50
Wanganui Harrier Club Associate Member - Donation
Wanganui Harrier Club Volunteer - No fee

Donation Amount

Date of Birth*

Age as at 31 Dec 2020*

Gender*

Male
Female

Mode

Walker
Runner

Grade*

Open
Veteran (35yrs +)

WHC Singlet required? $40

Price: $ 40.00 Quantity:

Approx size

Would you like to register with Athletics NZ?

Competitive ($66)
Social ($36)
No

Date of Birth*

Age as at 31 Dec 2020*

Gender*

Male
Female

Mode

Walker
Runner

WHC Singlet required? Children $25

Price: $ 25.00 Quantity:

Approx size

Would you like to register with Athletics NZ?

15-19yrs $51
7-14yrs $35
0-6yrs $10
No

Family Membership

Adult 1

Name*

First Last

Phone

Email

Date of Birth*

Age as at 31 Dec 2020*

Gender*

Male
Female

Mode

Walker
Runner

Grade*

Open
Veteran (35yrs +)

WHC Singlet required? $40

Price: $ 40.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Adult 1)

Competitive ($66)
Social ($36)
No

Adult 2

Adult 2 Name

First Last

Phone

Email

Date of Birth

Age as at 31 Dec 2020

Gender

Male
Female

Mode

Walker
Runner

Grade

Open
Veteran (35yrs +)

WHC Singlet required? $40

Price: $ 40.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Adult 2)

Competitive ($66)
Social ($36)
No

Child 1

Child 1 Name

First Last

Date of Birth

Age as at 31 Dec 2020

Gender

Male
Female

Mode

Walker
Runner

WHC Singlet required? Children $25

Price: $ 25.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Child 1)

15-19yrs $51
7-14yrs $35
0-6yrs $10
No

Child 2

Child 2 Name

First Last

Date of Birth

Age as at 31 Dec 2020

Gender

Male
Female

Mode

Walker
Runner

WHC Singlet required? Children $25

Price: $ 25.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Child 2)

15-19yrs $51
7-14yrs $35
0-6yrs $10
No

Child 3

Child 3 Name

First Last

Date of Birth

Age as at 31 Dec 2020

Gender

Male
Female

Mode

Walker
Runner

WHC Singlet required? Children $25

Price: $ 25.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Child 3)

15-19yrs $51
7-14yrs $35
0-6yrs $10
No

Child 4

Child 4 Name

First Last

Date of Birth

Age as at 31 Dec 2020

Gender

Male
Female

Mode

Walker
Runner

WHC Singlet required? Children $25

Price: $ 25.00 Quantity:

Approx size

Would you like to register with Athletics NZ? (Child 4)

15-19yrs $51
7-14yrs $35
0-6yrs $10
No

Cost and Terms

Consent*

I agree to the WHC Terms and Conditions (under 18s must have parental permission)

Total

$ 0.00

Payments can be made via bank deposit/internet banking (please use name as reference): Wanganui Harrier Club 11-6840-0683200-11

WHC Grades:

Adults aged 20-34yrs must select Open grade. Adults aged 35yrs+ may choose whether they compete at club events in the Open grade or Veteran grade. Once selected, they must stay in this grade for the season. This is for club events only and does not apply to Interclub, Centre or National events.

Athletics NZ Registration (1 April 2020-31 March 2021):

You must be registered as a competitive athlete with Athletics NZ if you wish to compete at any Centre or National event (including National Road Relays in Feilding this year). If you intend competing in athletics during the Summer, it is a good idea to sign up with Athletics NZ now as your registration is transferred into the Summer season. For additional benefits for competitive and social members, go to https://athletics.org.nz/about-us/member-benefits/

WHC Terms and Conditions:

I confirm that I agree to be a member of the Wanganui Harrier Club.

I know that running, walking, and volunteering for organised races and social events can be hazardous, and could cause injury or death. I will not take part in any WHC organised activities unless I am medically fit to participate. I agree to be present for pre-event safety briefings and understand that failure to do so may result in me being refused the right to participate. I understand that WHC activities will be held on both public and private land, including (but not limited to) farmland, parks, footpaths, and open roads. I assume all risks (which may include falls, contact with other participants, the effects of the weather, traffic, and the conditions of the road, footpaths, and private and public land) associated with being a member of this club and participating in club activities.

I understand that my safety (or the safety of my child) is my own responsibility and that all participants in WHC activities take part at their own risk. Children under the age of 14 must be adequately supervised by a parent or caregiver.

I understand that personal music players are not allowed to be used in club organised activities and I agree to abide by this rule.

I agree to abide by all WHC rules and understand that failure to comply with any guidelines may result in disqualification or suspension.

Emergency Contact Name

First Last

Emergency Contact Phone