Senior Membership Renewal OAC Senior Membership Renewal 2020 Senior membership renewal only (not for new member applications) Orangegrove AC Privacy Statement*When you become a member of or renew your membership with Orangegrove Athletics Club you can also choose to be registered as a member of Athletics Northern Ireland (you will have to register with Athletics Northern Ireland if you ever compete for the club in competition) If you select 'Senior Competitive Membership' on this form, we will provide Athletics Northern Ireland with your personal data which they will use to enable access to an online portal for you. You can also read the club privacy notice on our website - http://orangegroveac.co.uk/our-club/club-policies/ By ticking the box below you are confirming that you have read the above T&Cs. I have read and understood the above Terms and Conditions. Your DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Name Last Name Date of birth* Date Format: DD slash MM slash YYYY Gender*MaleFemaleAddress* Street Address Address Line 2 Town/City County Post Code Phone (field not used)MobilePhone*Mobile Phone (filed not used)Email address* Enter Email Confirm Email Medical DetailsMedical Consent*Any special category health data we hold on you is only processed for the purpose(s) of passing health data to coaches and club captains to allow the safe running of training sessions. I agree to my medical information being passed on to OAC coaches and club captains Medical InformationPlease indicate any medical condition/medication that the club should be aware ofDisabilityThe Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’Do you consider yourself to have a disabilityYesNoWhat is the nature of your disability? Visual Impariment Hearing Impairment Physical Impairment Learning Disability Multiple Disabilities Other For 'other' Please Specify*Further Disability DetailsPlease provide any additional information which you consider relevant to your disability which would assist coaches to ensure that you are fully supported at the clubEmergency Contact Details (ICE)ICE Contact Name* First Name Last Name ICE contact relationship to you*ICE contact phone number (field not used)*This may be a mobile phone numberICE contact phone number*ICE contact mobile phone number (filed not used)AthleticsVisit our website for an overview of the membership types -http://orangegroveac.co.uk/our-club/membership/ and for full explanation of Second claim membership see UKA Rules for Competition (Rule 21) - https://www.uka.org.uk/competitions/rules/Membership Type*Which membership type are you applying for? Senior Competitive - £50 pa + £10 ANI RegistrationSenior Competitive over 65 or full time Student (18+) - £40 pa + £10 ANI RegistrationSenior competitive Second Claim - £50 paAssociate Membership - £15 paWhat is the name of your First Claim Club?*Declaration*The Club rules and code of conduct can be found on the club website - http://orangegroveac.co.uk/our-club/club-policies/ I agree to abide by the OAC's club rules / policies including the codes of conduct. SignaturePlease type your full name to provide a digital signatureEmailThis field is for validation purposes and should be left unchanged.