Melton Olympic Cycling Club

 

 

MEMBERSHIP APPLICATION FORM

 

 

NAME

         …………………………………………………………………………………………………….…...

 

ADDRESS

         ………………………………………………………………………………………....……….……...

 

         ……………………………………………………………………………….…...…………………....

 

         …………………………………………………………………………………...……..……………...

 

         …………………………………………………………………………………………….…………...

 

POST CODE       ……………………….…………………………...

 

TEL. NO.           ………………………………………………..…..

 

E-MAIL ADDRESS

         …………………………………………………………………………………….………….………..

 

DATE OF BIRTH        ……………………………………………

 

Do you wish to be a First Claim, Second Claim or Social member?………………..…………….…….

 

If second claim, what is the name of your first claim club?

         ………………………..……….…………………………………………….………………………....

 

 

PROPOSED BY         ………………………..……………….………………………………...…….………..

 

 

SECONDED BY         ……………………………………………………….………………….………….…..

 

 

I hereby declare to abide by the club rules and the rules of the road and behave in a responsible manner when involved in club activities.

 

SIGNED ……………………………………………………      DATE         …………………………………….