Maidenhead & District Cycling Club

Application for Membership

To apply for membership, please fill out this form, print and sign it. Then bring it to one of our club meetings or events, along with a cheque made payable to "Maidenhead & District Cycling Club" for the amount shown in the Category option below.

A. Applicant's Details

Name:
Address:
Postcode:

Date of Birth:
Telephone:
Mobile:
Email:

I hereby apply to join the Maidenhead & District Cycling Club in the category indicated below and agree to abide by the constitution of the Club as laid down in the Rules and Regulations.
I understand that I participate in Club activities entirely at my own risk and that no liability whatever shall attach to the Club, its Officials or Members in respect of injury, loss or damage suffered by me, however caused.

Signed:

_________________ Date: _________________

For club use:

Proposed by:_________________

Seconded by:_________________

0712

Category:

Senior (£15.00)
Vet. 60+ (£10.00)
Junior 16-17 (£10.00)

Juvenile 12-15 (£5.00)
Second Claim (£10.00)

Options:

Event Passport (+£50.00 Sen)(+£25.00 Jun/Juv)

B. Second Claim

Please complete this section if you are joining the Club as a second claim rider.
First Claim Club:

C. Parental Consent

To be signed by the Parent or Guardian of applicant under the age of 18.

Name:
Address:
Postcode:

Telephone:
Mobile:

I, being the parent/guardian of the applicant, hereby agree to his/her taking part in the activities of the Maidenhead & District Cycling Club entirely at his/her own risk and without any liability whatever on the part of the Club, its Officials or Members in respect of injury, loss or damage suffered by him/her however caused.
As to Club Runs, I am aware that whilst the Club members will give assistance, neither the Club nor its members will undertake any responsibility for instruction or supervision and my son/daughter must assume full responsibility for his/her own safety and compliance with the law of the land relating to road travel.

Signed:

_________________ Date: _________________