Registration – Boksburg Athletic Club

Date

First Name

Last Name

ID Number * Please email a copy of your ID to info@boksburgathleticclub.co.za after submitting this form.

Physical Address *

characters

Cell Number *

Occupation

Year that you joined Boksburg Athletic Club This applies to continuous membership at the club, if you have broken membership and re-joined then you have to state the year that you re-joined.

Email Address *

Password *

School If you are a scholar please tell us the name of your school.

Grade If you are a scholar please tell us your current grade.

Who is your BAC coach? If you are a scholar please tell us the name of your coach.

Current ASA license number * If you don't have an ASA number please stop here and got to to register with the ASA and get your number.

Championship Number

Emergency contact name *

Emergency contact number *

Emergency contact email address *

I hereby apply for membership and declare that I am an amateur according to the definition laid down by Athletics South Africa. *

I agree

By typing your full legal name below, you acknowledge that this acts as your digital signature. *

If Applicant is under 18: As parent/guardian, I hereby consent to this membership and agree to the ASA declaration.

I agree

Parent/Guardian Full Name (Required if under 18) *

Parent/Guardian Phone Number (Required if under 18) *

Previous club: In the event that you are anew member transferring from another club. Please email your clearance letter to info@boksburgathleticclub.co.za after submitting this form.