Charleville, Co. Cork
086 3168954
info@northcorkac.ie
North Cork AC
Facebook
Twitter
Home
About
Policy Documents
News
Events
Membership
Fees
Sportshall Athletics Fees
Gallery
Contact
Login
Home
About
Policy Documents
News
Events
Membership
Fees
Sportshall Athletics Fees
Gallery
Contact
Membership
Club Membership Form
Step 1 of 3 - Choose Membership
33%
Volunteer Incentive Scheme:
All members / parents of a child member are asked to contribute their time on a voluntary basis towards the running and/or the development of the club. For this we provide a financial incentive by offering deductions to membership fees. To avail of this deduction each member is asked to volunteer themselves or provide a non-member volunteer for at least 2 of the events below, one of which must be the half-marathon as this raises significant funds for the club.
Do you wish to avail of the Volunteer Incentive Scheme?
*
Yes
No
Check which events you wish to volunteer for
*
You must select the Charleville Half Marathon and at least one other event.
Charleville Half Marathon - September 17th
Doneraile Park 5km Series - January 28th
Doneraile Park 5km Series - February 25th
Doneraile Park 5km Series - April 22nd
Membership Type
*
Please select the appropriate option
Little Athletics - €25
Child/Teen (Born 1998 to 2012) - €25
Adult (Born before 1998) - €45
Family Membership (2+) - €65
Membership Type (Reduction)
*
Please select the appropriate option
Little Athletics - €15
Child/Teen (Born 1998 to 2012) - €15
Adult (Born before 1998) - €25
Family Membership (2+) - €45
Total Fee
0,00 €
Name of adult
*
First
Last
Date of Birth
*
Name of Child 1
*
First
Last
Date of Birth of Child 1
*
Name of Child 2
*
First
Last
Date of Birth of Child 2
*
Name of Child 3
*
First
Last
Date of Birth of Child 3
*
Athletes Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Address
*
Street Address
Address Line 2
Town / City
County
County of Birth
Eligible to run for county of birth if other than Cork
Home Phone
If applicable
Mobile Phone
*
Number of parent/guardian only if athlete is U18
Email
*
Email address of parent/guardian only if athlete is U18
Are you interested in helping out with the Club organisation?
*
Yes
No
Please tick the roles that you feel you could help with.
Coaching
Committee
Transport
Supervision
Do you have any illnesses/conditions which the coach should know about?
*
Yes
No
Please enter details of your illness or condition here.
Do you have any previous/re-occurring injuries that the coach should know about?
*
Yes
No
Please enter details of your injury here.
Conditions
I acknowledge that photographs will be taken at athletic club events and are the property of North Cork Athletic Club. I consent to their use by North Cork Athletic Club for analysis, publication and the promotion of the Sport, including on their website, www.northcorkac.com
*
I consent
I hereby agree if accepted as a club member of North Cork Athletic Club to be bound by the Rules and regulations of the club. I agree that North Cork Athletic Club, its trustees and members shall not be responsible for any loss, damage or injury whatsoever suffered by me through the negligence or otherwise of any member of the club
*
I accept
Pay securely by debit/credit card via Stripe
MasterCard
Visa
Maestro
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
Expiration Date
Security Code
Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.
This iframe contains the logic required to handle AJAX powered Gravity Forms.
×
Login
Username
Password
Remember Me
×
Forgotten Password?
Username or Email
Lost your password?
|
Back to Login