Club Membership Registration Form

Midleton AC Club - Senior Section Existing Members Renewal Form

Complete the form below to request 2023 membership.
2023 Fees:

Individual €70

Couple €130

Junior €25 (born 2001, 2002, 2003)

Over 70 €0 (born 1952 or before; applies to existing members only)
Please select Type of Application*
Name*

First NameLast Name
Name2*

First NameLast Name
E-mail*

Confirmation Emailexample@example.com
E-mail2*

Confirmation Emailexample@example.com
Phone Number:*
Phone Number2:*
Address:*

Address Line1

Address Line 2

TownCounty

Postal Code
Birth Date:*

DayMonthYear
Birth Date2:*

DayMonthYear
Interests*

Road RunningTrack & FieldCross CountrySocial Events
Feedback
If you have any suggestions, comments or complaints, please add them below. All feedback is appreciated in helping us make this club even better.
Membership Rules
*

I agree to abide by the rules of Midleton AC
*

We agree to abide by the rules of Midleton AC
*

I agree to abide by the rules of AAI
*

We agree to abide by the rules of AAI
Privacy Policy
*

I agree to receive e-mails and texts from Midleton AC relaying club news and information.
*

We agree to receive e-mails and texts from Midleton AC relaying club news and information.
Photo Release
*

I hereby grant Midleton AC permission to use my image in good taste in promotional materials, posters, Web sites and other merchandise. I release Midleton AC from all liability of any nature in the use of any electronic or film image and or audio for advertising purposes.
*

We hereby grant Midleton AC permission to use my image in good taste in promotional materials, posters, Web sites and other merchandise. We release Midleton AC from all liability of any nature in the use of any electronic or film image and or audio for advertising purposes.
Medical Fitness
*

I am fully informed and aware that running and participating in club activities, including volunteering, are potentially hazardous. I understand I should not participate in any group activities (sanctioned or unsanctioned) unless I am medically fit and able to safely participate. I acknowledge it is my sole responsibility to ensure my level of medical fitness and do hereby declare that I am medically fit.
*

We are fully informed and aware that running and participating in club activities, including volunteering, are potentially hazardous. We understand we should not participate in any group activities (sanctioned or unsanctioned) unless we are medically fit and able to safely participate. We acknowledge it is our sole responsibility to ensure our level of medical fitness and do hereby declare that we are medically fit.
Existing 2022 members should note there will be a short time delay before your registration with Athletics Ireland for 2023 is processed.

Thank you!
Fee (€)

Payment Due

EURPlease check you have selected the correct application type at top of form

Payment Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Midleton AC Club - Senior Section Existing Members Renewal Form

Feedback

Membership Rules

Privacy Policy

Photo Release

Medical Fitness