Add to a familyToday Date Date Format: DD slash MM slash YYYY Add this member to an existing user's accountNoYesUser–Richard ParrTest NewAnother TestCellan NewAccountTRO TEST2PAUL BODDEYMala SinghDave DaugirdaJanine DurrantConor FitzpatrickChris YatesPaul MansonJan VanWeertSue UnsworthRachel BrittleHayley DaltonOwain CrispinGail HennessySusan JackmanHillsDylan WilliamsGeorge FernandezKathy WebbRussell JonesJeremy WilliamsZoe WoodwardPaul CatesElaine ThompsonPeter CoventryTom WardRuth RoseDavid CatoGraham WhiteRobert SommervilleJess SturgeonTom SturgeonJames PilchKate DalyNaomi DewsJane PannellGeoff NichollsJane StichburyGary TowersStephanie RashbrookVanessa ClyneAlex GounelasJohn FewGillian McKayNicola YatesMichelle BaxterWickhamstephen stoneSacha AcklandMaud HodsonGray McCarthyHeather SemmensSarah CareyPeter CraikToby LongCorrie MonaghanMartin HockeyJane RukinWhiteLouise TaylorFen ColesMary ArmitageBronya FrancisKristina CarmichaelDee MullnerPaul BrophyKate AlderseyStephen FentonChloe WoodheadPippa DowswellKatherine PeterJames HuddartSiobhan ParkerGiles BaileyRichard SeddonLucy BuntFergal McManusRosie-May ParkerWill SearleJacqueline SaintJanet HoskinAmanda HearnAlex TaylorDavid GreenwayJoanne JosephHannah RennieJohn BlackKevin LongAli SheppardAdrian FrostBen TerryLouise VacherJennifer PierpointLaura BlanksSteve BurrSimon CottleJoshua DentJoe Simmonds-IsslerDavid NelsonPhil McneillLee MilneAbbi ColeJames HowlettAlex DorrianBritta SchaedlerFlorence BearmanRhian EmanuelPeter McKerrellSian WilliamsOwen EspleyGlen ReddickJenny HeymannMatthew HassallMeghann NewcombeFrancesca GreenwayJane WellsBilal SheikhChristina WebbJessica VerrallUser emailPersonal DetailsMember IDUser IDUsername*The member will use this to login to their accountName* First Last Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*Select a genderMaleFemaleEmail * Contact detailsHome phone numberMobile phone numberAddress* Address Line 1 Address Line 2 City/Town County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Work phone numberEthnicity–White BritishWhite IrishWhite OtherWhite & Black CaribbeanWhite & AsianWhite & Black AfricanAsian/British Asian IndianAsian/British Asian PakistaniAsian/British Asian BangladeshiAsian/British Asian OtherBlack/Black British CaribbeanBlack/Black British AfricanBlack/Black British OtherChineseOtherEmergency contact detailsEmergency contact name First Last Emergency contact numberEmergency contact relationParentGrandparentGuardianFoster carerPartnerOther familyOtherExplain contact relationMembershipMembership CategorySelect a categorySenior 21/22 - Full with England Athletics Affiliation £15.00Senior 21/22 - Associate Member, Not Including England Athletics Affiliation £10.00Senior 21/22 - Subsidised, including England Athletics Affiliation £15.00-Please tell us more about yourself and your reasons for joining the club*-Your typical 5K time:Select...< 16 minutesBetween 16:00 - 19:00Between 19:00 - 21:00Between 21:00 - 25:00Between 25:00 - 30:00Between 30:00 - 35:00Between 35:00 - 40:00Between 40:00 - 45:0045 minutes >Estimated typical 5K timeMedical recordHas athma*YesNoNot SetHas diabetes*YesNoNot SetHas epilepsy*YesNoNot SetEpilepsy detailsHas allergy*YesNoNot SetAllergy detailsHas heart condition*YesNoNot SetHeart condition detailsHas medication*YesNoNot SetMedication detailsHas injury*YesNoNot SetInjury detailsHas visual impairment*YesNoNot SetVisual impairment detailsHas hearing impairment*YesNoNot SetHearing impairment detailsHas physical disability*YesNoNot SetPhysical disability detailsHas learning disability*YesNoNot SetLearning disability detailsOther important detailsParent/Guardian InformationParent/Guardian NameParent/Guardian RelationParent/Guardian Phone NumberPayment detailsDirect Debit Mandate IDMaster TotalPayment StatusAllowHoldShare your information with England HockeyClubBuzz and England Hockey, as part of the 'Approved Provider' scheme for Club Management Systems, have been working to make it easier than ever for clubs to share important statistics, such as membership figures, with England Hockey. It's hoped that by giving England Hockey such a rich insight into hockey in England, they can make their support even better for clubs. Your club has signed up Your club has signed up, and is sharing the following insights with England Hockey. Members – this includes a list of anonymised members, club committee members, umpires and coaches. You can opt to share their 'Personally Identifiable Information' with England Hockey, but by default, this information is kept anonymous to England Hockey. Teams – your club is sharing details about the number of teams in your club, their fixtures dates, times, and any other details stored in ClubBuzz related to that fixture. Venues – your club is sharing details about your club's venues, such as its name and location. Your club has the right to opt-out of the integration with England Hockey at any time.Would you like to share your personally identifiable information with England Hockey?*England Hockey would receive your name, date of birth, gender, email address, phone number, address, whether your are a player, coach, umpire, or club committee member. You can opt out at any time.YesNoWhat sort of communication do you want to receive from England Hockey?I want to receive all communication types from England HockeyI want to receive updates and news about hockey leaguesI want to receive marketing updates from England HockeyI don't want to hear from England Hockey at allSupplementary fieldsDate From 1 Date Format: DD slash MM slash YYYY Date To 1 Date Format: DD slash MM slash YYYY Date From 2 Date Format: DD slash MM slash YYYY Date To 2 Date Format: DD slash MM slash YYYY Date From 3 Date Format: DD slash MM slash YYYY Date To 3 Date Format: DD slash MM slash YYYY Migration IDMember Entry ID (supplementary)Membership StatusRegisteredRenewal PendingLapsedUnregisteredMigration StatusSubjectBodyEH ConnectsiteidrootsitenameFrom Join Form?-Emergency Contact Name*Please provide a name for someone who could be contacted in case of an emergency.-Emergency Contact Relationship to You*Select...ParentSpouse / PartnerSiblingFriendOtherRelationship of Emergency Contact-Emergency Contact Phone Number*Please enter a number from 00000000001 to 99999999999.Phone number-Do you have any health conditions that may be relevant? If so, please give details.*Health conditions-Have you previously been or are you currently a member of a running club or group who are affiliated with English Athletics? If so, please give the name of the club or group and your England Athletics athlete Unique Reference Number.*Previous EA-How did you find out about the club?*Select...From an existing memberOther word of mouthSaw runners or clubhouseOnline searchLocal pressSocial mediaOtherHow did you find out about the club?You need to enter an email before you can submit!