Melton Olympic Cycling Club

MEMBERSHIP APPLICATION FORM

NAME

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ADDRESS

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POST CODE ……………………….…………………………...

TEL. NO. ………………………………………………..…..

E-MAIL ADDRESS

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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?

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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 …………………………………….