Apply for IEKAC membership

If you would like to become a member of Invicta East Kent Athletic Club, please complete the form below and we will contact you.
  * required fields
 
First Name(s) *
Surname *
Known As if different from First Name
 
Gender *
Date of Birth * / /
 
Address *
 
 
Town/City *
County *
Postcode *
 
  Please provide at least one telephone number
Home Phone
Work Phone
Mobile Phone
 
Email Address *
 
Place of Birth
 
Next of Kin (Name) required if under 18
Next of Kin (Phone) required if under 18
 
Coach
 
Medical Notes
 
Emergency Contact - Name *
Emergency Contact - Phone *
 
Do you (or your parent/guardian if under 18) give permission for photos of you to be used in the press, on the website and/or for club publicity?
Select
 
  Applicants under 18 years of age must have a parent/guardian join IEKAC as a Friend of Invicta:
Friend of Invicta - First Name *
Friend of Invicta - Surname *
Friend of Invicta - Gender *
Friend of Invicta - Date of Birth * / /
Friend of Invicta - Phone *
Friend of Invicta - Email Address *
 
  Under 18 Consent (to be completed by the parent/guardian of U18 applicant):
*
Parent/Guardian Name *