Application Form

Prior to completing this form please read the accompanying guidance documents which outline the the key criteria for applications.

Club Run places are limited and therefore will be allocated according to the key criteria and strength of applications. Please note only one application per club is submitted and should be submitted by a Head Coach, club officer or member of the club committee.

CLUB DETAILSName of Club

CountyLocation of primary training venue

Postcode Website

CONTACT DETAILS Name

Your role within the clubTelephone Number

Email addressName of Head Coach or Leader If different from the above

Head Coach/Leader QualificationTelephone Number

Email addressCLUB MEMBERSHIP INFORMATION

Overall club membership size* No. of EA registered members

ABOUT YOUR CLUB Type of club

Describe your club, membership and ethos in one or two short sentences.

.

Tell us about your club’s recent achievements or success stories.

This could be anything from growth in membership to winning a team

championship event or development of your club structure and coaching.

Tell us about your clubs training or coaching structure.

This could include number and type of sessions each week, different ability

groups, etc

ABOUT YOUR CLUB’S RUNNERSWhat sorts of races or events do

your members normally take part in and how often? Circle all that apply.

Please answer with the majority of the membership in mind.

Please note there are no right or wrong answers. This information will

help us form a better picture about your club.

parkrun events never rarely sometimes often5k road races never rarely sometimes often10k road races never rarely sometimes often10 mile races never rarely sometimes oftenHalf–Marathons never rarely sometimes oftenMarathons never rarely sometimes oftenUltra Distance never rarely sometimes oftenRoad Relays never rarely sometimes oftenCross-country never rarely sometimes oftenTrack never rarely sometimes oftenMulti-terrain never rarely sometimes oftenTriathlon Events never rarely sometimes often

Please tell us about the ability range of your club runners?

Please provide us with some information on the type of runners

your club supports.

Please note there are no right or wrong answers. This information will

help us form a better picture about your club.

Fastest group Slowest groupEg. 5k 15-17 mins 28-30 mins

5k10k

Half-MarathonMarathon

ABOUT COMPETITIONIn the last 12 months have your

members taken part in any of the England Athletics Road Running

Championship Events?Please delete yes/no as appropriate.

Where you have answered ‘yes’, please provide rough numbers of particpants

where possible.

Championship Event No. of runnersMarathon – Virgin London Yes/No

Half-Marathon – Great North Run Yes/No10 mile – Great South Run Yes/No

10k – Age UK Leeds Abbey Dash Yes/NoArea 4 & 6 Stage Relays Yes/No

National 4 & 6 Stage Relays Yes/NoArea 6 & 12 Stage Relays Yes/No

National 6 & 12 Stage Relays Yes/No

If your club is not currently participating in any of the above events we would welcome your

feedback as to why that is?

Please provide information on other popular events and races

locally or nationally that your club members support?

You do not need to list them all, but just those events that the club supports

in large numbers.Does your club host any events of its own? Please provide the name

of the race, date and the UKA race license number.

Event Name:Race Distance(s)Licensing Body:License Number:

England Athletics in partnership with DW Fitness First.

Would your club be interested in holding a Club Run session at or

from your local DW Fitness gym?Please note you are not commiting to this at this stage and this will depend on arrangements with the local gym,

but potentially offers clubs an alternative or extra session.

Please state yes/no. If ‘yes’ provide venue and postcoide of your nearest DW Fitness First gym. For your nearest gym go to:https://www.dwfitnessfirst.com/find-a-gym/

Would your club be willing to receive further information from

runbritain on putting on a licensed event?

WHY YOUR CLUB?Please tell us in no more than 250

words why you would like your club to take part in Club Run and

what you hope to get out of it.

SIGNATURE If successful in our application to Club Run we will commit to the expectations set out in the guidance documents.

Date:

Signed:

Please send your completed application form to England Athletics Road Running Coordinator, Charlotte Fisher, cfisher@englandathletics.org