WREKINSPORT CYCLING CLUB

Membership Application Form 2011

I wish to apply for membership to Wrekinsport Cycling Club as:

1^st Claim - £8
2^nd Claim - £8
Junior (16-18 years) - £5
Juvenile (Under 16) - £3
Family Membership - £12

Name(s) ………………………………………………………………………
………………………………………………………………………................
Address ………………………………………………………………………
………………………………………………………………………................
………………………………………………………………………................
Postcode …………………………………………………………………..…
Date of Birth ………………………………………………………………….
Tele No. ……………………………………………………………………....
E-Mail ………………………………………………………………………...

Other contact name and number in case of emergency
……………………………………………………………………...................

I agree to abide by the rules of the club

Signed ………………………………………………………………………

I understand that all applications for membership are subject to approval by the Club Committee.

FOR APPLICANTS UNDER THE AGE OF 18

I agree to my son/daughter taking part in the Club activities at his/her own risk, without any liability what so ever on the part of the Club, its officials or members, in respect of any injury, loss or damage suffered by him/her, however caused.

Signed (Parent/Guardian)………………………………………………………...

Please return this form to:

Mr Dave Poulter
32 Sunbury Drive
Trench
Telford
TF2 7EA