Application Form

 

Title: Mr / Mrs / Miss / Ms                                          Surname:                                          

 

Forename (s):                                                            Date of Birth:                                    

 

Address:                                                                                                                                

 

                                                                                                                                               

 

                                                                                                                                               

 

Postcode:                                                     

 

Tel (daytime):                                                            Tel (evening):                                                          

 

Email address:                                                                                                                     

 

What type of riding do you prefer: (please tick)

 

X –country                                                       Downhill                                            

Single track                                                    General off road                                 

 

Do you require transport to/from rides or events? (Yes or No)                        

Are you prepared to provide transport to/from rides or events?                    

 

Level of fitness: (Poor/Average/Good/Very good)                          

 

Please list any health conditions:                                                                                     

 

Emergency contact name & relation:                                                                                

           

Address:                                                                                                                                

 

                                                                                                                                               

 

                                                                                                                                               

 

Postcode:                                                     

 

Tel (daytime):                                                            Tel (evening):                                                          

I accept that Cyclone Mountain Biking Club will be keeping the above information about me in connection with membership of the club.  I give explicit consent to the holding of this information, and its use in connection with the administration of the club - this will include membership management and communications.  Any of the information provided will not be passed to any third parties outside the club committee without your consent.

Signed:                                                                                   Date:                                      

 

The membership joining fee is £5. The annual fee for membership is £15.

Please return your signed application form complete with membership and/or annual fee (cheque) made payable to ‘Cyclone MBC’. Address them to Caroline Taylor, 35 Latimer,Calverton End, Stony Stratford, Milton Keynes, MK11 1HP