EAST ANTRIM RAMBLING CLUB - MEMBERSHIP APPLICATION (REVISED 13/6/23)

Type of Membership Required (please tick):	Single Person (£25 annually)		Family Couple (£40 annually)
Name (1^st Applicant) (App)
Name (2^nd Applicant) (App)
Address & Postcode:
Telephone (1^st App)	Home:	Mobile:
Telephone (2^nd App)	Home:	Mobile:
E Mail Address: (1^st App)
E Mail Address: (2^nd App)

PAYMENT OF SUBSCRIPTIONS: Payment can be made in one of the following ways:

(1) Cheque made payable to East Antrim Rambling Club and passed to the Treasurer,

(2) Cash payable to the Treasurer and

(3) On-line Transfer (the club’s bank details are as follows: Sort Code: 09-01-29 and Account Number: 00584559.

CLUB TREASURER

Alastair Jack,
12, Glencroft Road,
Newtownabbey
BT36 5GD.

Tel: O2890 835956

Mobile: 07597 995290.

Email: alastrjack@aol.com

Grateful if you would advise how you heard about our Club?

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Grateful if you would advise what made you want to join our Club?

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PTO

The following additional information is required by Sport NI (in confidence) to enable monitoring under Sport NI’s Active Clubs Programme.

1^ST APPLICANT

Male / Female……………………………… Ethnic Origin……………………………………….

Age Range, (please circle) Under 18, 18-25, 26-40, 41-59, 60+

Do you consider yourself to be disabled? (Please circle) Yes No

If yes could you expand on this? (Please circle), Mobility Issues, Learning Disability, Hearing, Visual Impairment.

2^nd APPLICANT

Male / Female……………………………… Ethnic Origin……………………………………….

Age Range, please circle, Under 18, 18-25, 26-40, 41-59, 60+

Do you consider yourself to be disabled? (Please circle) Yes No

If yes could you expand on this? (Please circle), Mobility Issues, Learning Disability, Hearing, Visual Impairment.

PLEASE PASS YOUR COMPLETED APPLICATION (BY HAND OR POST) TO THE CLUB SECRETARY (Teresa Malone) AFTER YOU HAVE MADE PAYMENT TO THE TREASURER.

Club Secretary
Teresa Malone

31, Collinbridge Gardens,

Glengormley,

Newtownabbey

BT36 7SU

Mob: 07896 330095.
Email: tmalone31@hotmail.com

PLEASE FAMILIARISE YOURSELF WITH THE CLUB’S WALK PARTICIPATION CONDITIONS / CODE OF BEHAVIOUR FOR WALKERS AND ADDITIONAL NOTES FOR WALK LEADERS WHICH CAN BE FOUND ON THE CLUB’S INTERNET HOME PAGE (www.earc.org.uk)

1st Applicant

Signature…………………………………………………………………………………………Date………………………….

2^nd Applicant

Signature…………………………………………………………………………………………Date………………………….

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