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
Juvenile Under 16 years old 6-00
Junior 16 & 17 years old and full-time students 13-00
Associate 12-50
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 * 24-00
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)

continued

Parental Consent
 
To be signed by the parent or guardian of Club Members under the age of 18.
I (Name & Address)
being the parent/ guardian of
Hereby agree to his/ her taking part in the activities of Mildenhall Cycling Club and acknowledge that I have been advised as to the nature of the Clubs activities.
In respect to Club Runs, I am aware that whilst Club members will give assistance when an emergency has occurred, neither the Club, nor its members undertake responsibility for instruction or supervision. My son/ daughter must assume full responsibility for his/ her own safety and compliance with the law of the land relating to road travel. I have discussed the situation with my son/ daughter and am satisfied that he/ she is sufficiently responsible and competent to ride in a maner, which is safe for him/ her and others.
I agree to my son/ daughter taking part in Club activities at his/ her own risk and without any liability on the part of the Mildenhall Cycling Club, its officials or members in respect of any injury, loss or damage suffered by him/ her however caused.

There are occasions when a Club or media photographer/film-crew may be present at the sessions. Please delete Yes or No as required.

YES - I agree to my son/daughter being photographed or filmed. I also agree to the use of the resulting images by Mildenhall Cycling Club/media organisations for the purposes of publicity.
NO - I do not agree to my son/daughter being photographed or filmed.

Signed Date
Club Witness Date