| First Name | |
| Surname | |
| Address | |
| Tel.Number | |
| E-Mail Address | |
| Post code | |
| 1st or 2nd Claim | |
| Any other club | |
| D.O.B. | |
| Signature | |
| Date | |
| Membership
is £8 per year 1st Claim, £3 per year 2nd Claim Cheques payable to Wolds Veteran Runners Club Please enclose SAE |
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| Post to S Green, 142 St. Nicholas Drive, Grimsby, DN37 9RF | |