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
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?
  Under 18 Consent (to be completed by the parent/guardian of U18 applicant):
Parent/Guardian Name *