2019 Family Membership
First Name
Select Club
ASH
BWRSC
EIS
EMR
IND
LSST
NthLon
SWF
WISS
Address
Last Name
Membership Type
Adult £45
Minor (U18) £30
Official £10
Affiliate £10
Life Member
Postcode
Race Number
Email:
Gender
Date of Birth
Phone
Male
Female
Parental Consent
I agree to the above minor applying for FISS membership in 2019
I agree to officiate two non-championship events in return for a £10 membership diiscount
Medical Details
Are you aware of any underlying medical condition that restricts your ability to exercise, compete or attend competitions
No
Yes
Please provide full details
Are you regularly taking prescription medication
Yes
No
Please provide full details
Do you have any known allergies
Yes
No
Please provide full details
If your answer to any of these three medical questions changes during the year, you MUST inform your club officials AND FISS Membership Secretary (memberships@inlinespeed.co.uk) immediately.
If you do NOT agree to images/video/reference of you being used by FISS or it's officers please tick this box
By checking this box, I/we wish to apply for membership to the Federation of Inline Speed Skaing Ltd. for the year 2019. I/we agree to abide by it's rules and participate as a member in a fair and respecting manner.
Add a family member
First Name
Last Name
Please provide full details
Please provide full details
Please provide full details
Select Club
ASH
BWRSC
EIS
EMR
IND
LSST
NthLon
SWF
WISS
Gender
Male
Female
Membership Type
Adult £45
Minor (U18) £30
Official £10
Affiliate £10
Life Member
Race Number
Email
Date of Birth
Phone
I agree to officiate two non-championship events in return for a £10 membership diiscount (officials only)
Parental Consent
(U18s Only)
I agree to the above minor applying for FISS membership in 2019
Parents Name
Medical Details
Are you aware of any underlying medical condition that restricts your ability to exercise, compete or attend competitions
Yes
No
Are you regularly taking prescription medication
Yes
No
Do you have any known allergies
Yes
No
If your answer to any of these three medical questions changes during the year, you MUST inform your club officials AND FISS Membership Secretary (memberships@inlinespeed.co.uk) immediately.
If you do NOT agree to images/video/reference of you being used by FISS or it's officers please tick this box
By checking this box, I/we wish to apply for membership to the Federation of Inline Speed Skaing Ltd. for the year 2019. I/we agree to abide by it's rules and participate as a member in a fair and respecting manner.
Add a family member
First Name
Last Name
Date of Birth
Gender
Select Club
ASH
BWRSC
EIS
EMR
IND
LSST
NthLon
SWF
WISS
Male
Female
Membership Type
Adult £45
Minor (U18) £30
Official £10
Affiliate £10
Life Member
Race Number
Email
Phone
I agree to officiate two non-championship events in return for a £10 membership diiscount (officials only)
Parental Consent
(U18's Only)
I agree to the above minor applying for FISS membership in 2019
Parents Name
Medical Details
Are you aware of any underlying medical condition that restricts your ability to exercise, compete or attend competitions
Yes
No
Please provide full details
Are you regularly taking prescription medication
Yes
No
Please provide full details
Do you have any known allergies
Yes
No
Please provide full details
If your answer to any of these three medical questions changes during the year, you MUST inform your club officials AND FISS Membership Secretary (memberships@inlinespeed.co.uk) immediately.
If you do NOT agree to images/video/reference of you being used by FISS or it's officers please tick this box
By checking this box, I/we wish to apply for membership to the Federation of Inline Speed Skaing Ltd. for the year 2019. I/we agree to abide by it's rules and participate as a member in a fair and respecting manner.
Add a family member
First Name
Last Name
Date of Birth
Gender
Select Club
ASH
BWRSC
EIS
EMR
IND
LSST
NthLon
SWF
WISS
Male
Female
Membership Type
Adult £45
Minor (U18) £30
Official £10
Affiliate £10
Life Member
Race Number
Email
Phone
I agree to officiate two non-championship events in return for a £10 membership diiscount (Officials Only)
Parental Consent
(U18's Only)
I agree to the above minor applying for FISS membership in 2019
Parents Name
Medical Details
Are you aware of any underlying medical condition that restricts your ability to exercise, compete or attend competitions
Yes
No
Please provide full details
Are you regularly taking prescription medication
Yes
No
Please provide full details
Do you have any known allergies
Yes
No
Please provide full details
If your answer to any of these three medical questions changes during the year, you MUST inform your club officials AND FISS Membership Secretary (memberships@inlinespeed.co.uk) immediately.
If you do NOT agree to images/video/reference of you being used by FISS or it's officers please tick this box
By checking this box, I/we wish to apply for membership to the Federation of Inline Speed Skaing Ltd. for the year 2019. I/we agree to abide by it's rules and participate as a member in a fair and respecting manner.
Add a family member
First Name
Last Name
Do you have any known allergies
Date of Birth
Select Club
ASH
BWRSC
EIS
EMR
IND
LSST
NthLon
SWF
WISS
Gender
Male
Female
Membership Type
Adult £45
Minor (U18) £30
Official £10
Affiliate £10
Life Member
Race Number
Email
Phone
I agree to officiate two non-championship events in return for a £10 membership diiscount (officials only)
Parental Consent
(For U18 Members only)
I agree to the above minor applying for FISS membership in 2019
Parents Name
Medical Details
Are you aware of any underlying medical condition that restricts your ability to exercise, compete or attend competitions
Yes
No
Please provide full details
Are you regularly taking prescription medication
Yes
No
Please provide full details
Yes
No
Please provide full details
If your answer to any of these three medical questions changes during the year, you MUST inform your club officials AND FISS Membership Secretary (memberships@inlinespeed.co.uk) immediately.
If you do NOT agree to images/video/reference of you being used by FISS or it's officers please tick this box
By checking this box, I/we wish to apply for membership to the Federation of Inline Speed Skaing Ltd. for the year 2019. I/we agree to abide by it's rules and participate as a member in a fair and respecting manner.
Fees Due