Applicants Details
Full Name Date of Birth
Address
Post Code Telelphone No
Email
Former Club (If joining from another Club)
Signature Date
Membership Fees
Club Membership
Senior 18 years old and over £24-00
Over 60 / Unwaged £18-50
Family Maximum of 2 adults and 3 children
(up to the age of 16 yrs) living in the same household.		 £50-00
Associate   £12-00
2nd claim   50% of above
  FAMILY MEMBERSHIP Please complete a seperate form for each family member.
       
British Cycling
If you are not a member and wish to join please contact British Cycling direct.
Under 12 If already a member,
please quote your Membership No .................................
Youth (12-15) If already a member,
please quote your Membership No .................................
Junior (16-18) If already a member,
please quote your Membership No .................................
Senior (19+) If already a member,
please quote your Membership No .................................
Family If already a member,
please quote your Membership No .................................
Racing Licence If already a member,
please quote your Membership No .................................
Cycling UK (Cyclists Touring Club)
Affiliate *   £28-00
Full Member Membership Number .................................  
* This allows you to take part in Club activities and time-trials, but not road, track, Cyclo-Cross or mountain bike racing where British Cycling membership and either a full or day racing licence is required
         

Total Due

 (cheques payable to Mildenhall CC)