Registration Form

Registration Form

Personal Details = required

Full Name

Home Address

Home Phone

Mobile Phone

Email Address

Alternate Email

Date of Birth

Gender

Male Female

Occupation

(Please indicate if you would be willing to help the club should it need your expertise.)

Membership Start

When would you like your membership to start?

As Soon As Possible Specific Date

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost
	Beginner This is a guest membership and should be chosen by anyone wanting to join our beginners courses Only available to people aged 18 or over.	£0.00
	Base Adult Membership Only available to people between the ages of 18 and 69 inclusive.	£20.00
	Affiliated Adult Member Only available to people between the ages of 18 and 69 inclusive.	£40.00

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://www.rugeleyrunners.co.uk/Home/TermsAndConditions) and the Privacy Policy (https://www.rugeleyrunners.co.uk/PrivacyPolicy;).

Signature

Date

Please return completed forms to: Mrs Laura Gambrill, 10 Hampton Court, Rugeley, Staffordshire, WS15 2BF, United Kingdom

Use this form to send an email to another member. You may only send to one member at a time. Your registered email address will be passed on to this member but you may also include alternative contact details.

Note: Emails sent via the website are not entirely private. A copy of every email is held on the database and this can be accessed by certain club administrators using the Sent Emails page.

To

From

Alternative contact email

Another email address which the recipient can use to contact you.

Alternative contact details

Other contact details which the recipient can use to contact you e.g. phone number.

Subject

Message

Copy this message to my email address

Solid

Regular

Light

Duotone

Brands

No matching icons.

ID

Title

Description

Categories

File

(no previous upload)

You do not have permission to upload documents. You cannot upload new documents because you are out of disk space.

You have been automatically logged in.

has been added to family group:

Registration successfully completed for .

Requested Membership Subscriptions

One or more of the requested Membership applications require approval. You will be emailed if your request has been approved and, at that point, you will be able to view and accept or reject the membership offer and proceed with payment. will be emailed once the request has been approved and, at that point, they will be able to view and accept or reject the membership offer and proceed with payment.

Subscriptions have been automatically approved and have been added to your basket. Please now proceed there to make payment.

Pay for Subscriptions

Reference	Name	Category	Costs
			Joining Fee Cost /	View Manage

Group Subscriptions

- :

You have requested one or more group membership subscriptions. You should now use the register buttons below to add additional members into the available slots.

No.	Membership
	One of:

Next Steps

GoCardless Direct Debit —

scheduled to be collected automatically by GoCardless. There is no need to record manually unless the GoCardless notification has been missed.

If you do record it: entering the GoCardless payment reference (e.g. PM...) will allow the duplicate notification to be safely ignored. If you use an unknown or incorrect reference, myClubhouse may incorrectly mark the as paid when it processes the collection.

Stripe —

scheduled to be collected automatically by Stripe. There is no need to record manually unless the Stripe notification has been missed.

If you do record it: entering the Stripe charge reference (e.g. ch_...) will allow the duplicate notification to be safely ignored. If you use an unknown or incorrect reference, myClubhouse may incorrectly mark the as paid when it processes the collection.

Scheduled Electronic Payment

scheduled to be collected automatically by . There is no need to record manually unless the provider's notification has been missed. If you mark it as paid and the automatic collection also succeeds, the payment may be recorded twice.

GoCardless Direct Debit Stripe — RE: : GoCardless Direct DebitsStripe paymentsPayments via are normally recorded automatically. There is no need to record manually unless has been missed. Please enter the exact payment reference where possible. Payments with different references must be recorded separately.

Payee

Paying User

Payment Date

Payment Method

Amount

£

Refunds may be recorded using negative amounts.

Payment Reference

Notes

Allocation to Due Payments

Select the due payments that are covered by this received payment.

Unallocated Amount

£

	ID	Purchaser	Purchase	Amount	Due Date	Allocated Amount
— scheduled for automatic collection
						£

No due payments.

Applied Discounts

Loading preview …

Error:

Subscription is .

Confirmed payments
Already recorded
To be recorded

Payment subscription(s):

— inactive

All payments are recorded, but the subscription is no longer active and at least one payment subscription is still marked active. Click Proceed to deactivate it and cancel any future due payments.

All confirmed payments are already recorded.

Payment on is for .

This amount doesn't match the sum of the payment subscriptions. Please enter how the amount should be distributed:

Payment Subscription	Suggested	Actual Amount

Total entered

Enter 0 for any subscription whose payment has not been collected — it will be marked inactive.

Actions performed:

No payments required recording.

{"HeaderName":"RequestVerificationToken","RequestToken":"CfDJ8OEkW8Hh089IhtvmFaPXdxKBgrbM-2iI21eW7dVlmlXzquznym0njtp2rI7YQeDeW1i2QPhAdisQebWxLXl7m4J1cAfe6gSjVvEwA8GQ5_gSz8tX8MhZcelik0SEVZUzyE3rN3OmpA0a28BNKXG_IIA"}