MEMBER REGISTRATION

Full name*

Email*

Mobile number*

Do you consent to being added to club WhatsApp groups?*
YesNo
Address line 1*

Address line 2

Town/City*

County*

Post code*

Gender*
MaleFemale
Date of birth*

What best describes your ethnicity?*
White – BritishWhite – Other nationalityAsian or Asian BritishBlack, Black British, Caribbean or AfricanMixed or multiple ethnic groupsArabOther ethnic groupPrefer not to say
Emergency contact name & number*

Do you have an existing medical condition which might result in you requiring urgent medical attention? If yes please provide details below (or type ‘none’ for no).*
This information will remain strictly confidential and will only be accessible to the relevant senior club members.

Are you medically trained?
If yes, please provide details ie. doctor, nurse, paramedic, first aider.
Are you a new member or renewing your membership?*
New memberRenewing
Group you usually run in or if a new member pace you normally run at*
Easy pace – over 10 min mile pace / over 6.30min/kmMedium pace – 8:30 – 10 min mile pace / 5.15 – 6.30min/kmFast pace – 7.30 – 8:30 min mile pace / 4.30 – 5.15min/km
How did you hear about us?*
RenewingSearch engine / GoogleFriends or familyMet one of our runnersSaw us at parkrunSaw us on FacebookOther
If other, please specify.

Membership type – please select the relevant membership from the options below*
CPFR membership (£10.00) with England Athletics registration (£17.00)CPFR membership only (£10.00)CPFR concessionary membership only (£5.00)CPFR concessionary membership with England Athletics registration (£22.00)
England Athletics affiliation number (if known)

Do you belong to another club? If so, which one?

Please tick the box to give consent to Crystal Palace Fun Runners holding personal information about you for the purpose of the administration of your membership with the club (no marketing). In doing so you agree to be being contacted by the club by email, phone and text (SMS) message. By checking the box, you also agree to adhere to the Club’s Safeguarding Code of Conduct, in line with England Athletics Club Standards.Once you submit the form, your details will be provided to England Athletics and you will receive a request for payment from England Athletics directly.
I consent