Membership Form

We are affiliated to Triathlon England, England Athletics.org and Cycling Time Trials

Membership Fees from 1st April 2018

Please read and select carefully – if you do not include the additional UK Athletics affiliation, you will not be able to run as a first claim member for Tri-Logic Cornwall.

The membership year runs from 1 April to 31 March and costs £15 per year plus an additional  £15 if you want to also be affiliated to England Athletics.

membership form 2018-19

1. Membership requiredPlease select membership requiredFull membership £15Full with England Athletics £30(required)
2. Full Name(required)
3. Genderplease selectmalefemale(required)
4. Date of Birth(required)
5. Address(required)
6. Postcode(required)
7. Email address(valid email required)
8. Telephone no.(required)
9. Mobile(required)
10. Current membership no.(required)
11. Member of any other Athletics Clubplease selectyesno
12. 1st or 2nd claim memberplease select1st claim2nd claimHonorary
13. England Athletics Reg no. (if known)
14. Your health is your responsibility, but please let us know if you have any medical conditions/ take any medication/ have any allergies that we should be aware of:
15. The information you provide here will be included on your membership card, and will be usd in the event of an emergency. You will need to bring your membership card to every club training session(required)
16. Emergency contact details:
17. In the event of an emergency, please provide contact details of a family member or friend.
18. Full Name(required)
19. Relationship(required)
20. Mobile Number(required)
21. Land-line Number(required)
23. I confirm that I understand that participation in Tri-Logic Triathlon Club activities is entirely at my own risk, and that no resposibility for any injury sufferd by me shall be attached to Tri-Logic Cornwall - we recommend that you join British Triathlon www.britishtriathlon.org or British Cycling www.britishcycling.org to cover your Public Liability in the event that something should happen to you during a club ride or race.
25. I give permission for you to display my contact details on our membership list (for internal club use only) and I agree to the use of photos of club activities for promotional and reporting purposes only, and on the club website.
26. Signed:(required)
27. Date:(required)
28. Payment can be made online using the following details:
29. Sort code: 30-98-76 Account number: 01586157 - please use reference 'membership' when paying online.
30. Payment methodplease selectChequeBACScashother(required)
31. If paying by cheque please make to Tri-Logic Cornwall and send to:-
32. Jason Beever, Radnor Farm, Radnor, Redruth.
33. TR16 4BQ
34. Informed Consent
35. Informed consent form for exercise prescription. Programme objectives and procedures I understand that the purpose of the exercise programme is to provide safe and individualized exercise to improve health and fitness. Exercises may include: • Cardiovascular activities – Swimming, both in swimming pools and open water, cycling, be that on static bikes, on off-road trails or on open roads and running, in track, trail and road environments. • Resistance training activities using resistance machines, free weights or body weight to improve muscular strength or endurance. • Cool down and flexibility exercises to improve movement around joints and range of movement.
36. Potential Risks The exercise programme is designed to place a gradually increasing workload on the cardiovascular and muscular systems and thereby improve their function. The reaction of the cardiovascular and muscular system to such exercise cannot always be predicted with complete accuracy. There is a risk of certain changes that might occur during or following the exercise. These changes could relate to blood pressure and heart rate.
37. Potential benefits I understand that a programme of regular exercise has been shown to be beneficial. Some of these benefits include: • A decrease in risk of heart disease • A decrease in body fat • Improved blood pressure • Improvement in psychological function • Improvement in aerobic fitness The relevant exercise programmes have been explained to me and my questions regarding the programme have been answered to my satisfaction. I understand that I am free to withdraw at any time. The information obtained will be treated as private and confidential.
38. Signed:(required)
39. Date:(required)
40. Physical activity readiness questionnaire (PAR-Q)
41. This PAR-Q is designed to help you to help yourself. Many benefits are associated with regular exercise and completion of the PAR-Q form is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose a problem or hazard. The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense is your best guide for answering the questions.
42. 1: Has your doctor ever said that you have a heart conditions and that you should only do physical activity recommended by a doctor?YesNo(required)
43. 2: Do you feel pain in your chest when you do physical activity?YesNo(required)
44. 3: In the past month, have you had chest pain when you were doing physical activity?YesNo(required)
45. 4: Do you lose your balance because of dizziness or do you ever lose consciousness?YesNo(required)
46. 5: Do you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in physical activity?YesNo(required)
47. 6: Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?YesNo(required)
48. 7: Do you know of any other reason why you should not do physical activity?YesNo(required)
49. If you have answered YES to any of the above questions, then you are required to gain consent from your doctor before participating in any of the exercise programmes. If you have answered NO to all the above questions and you have reasonable assurance of your suitability for: An exercise programme which may include; a warm up, cardiovascular training by way of swimming, cycling, running or gym based activities and a cool down or stretches. You are advised to postpone entry into the programme if you feel unwell or have a temporary illness. You must inform your coach of any changes to your health status whilst engaged in your training programme.
50. Signed:(required)
51. Date:(required)