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Stroud & District AC Stroud & District AC Trial Membership

You will require the Stroud & District AC club code to complete this form. If you do not have the club code please contact Stroud & District AC.

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First name

Last name

Confirm Email

Club code What's this ?

Date of birth

Contact Details

Address 1

Address 2

Town / City

Postcode

Mobile No.

Phone No.

ICE Details ( I n C ase of E mergency )

Contact Name

Contact Number

Alternative Contact Name

Alternative Contact Number

Medical Conditions you wish Stroud & District AC to be aware of

In case of emergency, this information will be visible to club admins with member, organise, or training permissions, and to leaders and leader supports of the training groups you belong to. Please only provide information relevant to your participation in Stroud & District AC activities. If you have any concerns about sharing this information, contact Stroud & District AC directly.

Once you have registered for a connectMyClub account, you can withdraw your consent for connectMyClub to store your medical notes at any time, and doing so will delete them. If you have not yet registered and wish to have medical notes you've submitted deleted, contact connectMyClub via our contact form.

Anything you'd like to ask, or tell Stroud & District AC? (optional)

Spiderbro: Don't change me bro, I'm tryin'a catch some flies!

Name	Purpose	Expires
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_ga_XXXXXXXX	Persists session state and tracks page views within a session on https://connectmy.club	2 years
_gid	Stores and updates a unique value for each page visited, used to count and track page views	24 hours