BURY CLARION CYCLING CLUB

Membership Application Form

Do NOT use this form for renewals

PRINT your details below in BLOCK CAPITALS including your home address

Fields highlighted are mandatory

* Name (Please include first name) / Mr/Mrs/Ms/Miss/Dr/Other
House Name
* House Number & Street / Road
Locality
* Town / City
County
* Post code
Country (only if overseas)
Telephone number (not required if under 16)
email address (lower case) (not if under 16)
* Section / ******************* BURY *******************
* Date of Birth
* Gender / Male / Female
* Are you a member of another cycling club? / Yes / No (delete one) If no ignore the next question
If so, will you be a 1st claim Clarion member? / Yes / No If no see the rules regarding 2nd claim membership

·  All members are first claim unless you indicate otherwise.

·  A first claim Clarion member races in all open events as a Bury Clarion C.C. member.

·  See Clarion rule 4.5 regarding 2nd claim membership and prize eligibility.

·  Senior members are aged 18 and over, junior members must be under 18.

·  Family Membership: If 2 senior members live at same address then juniors at that address are free.

Please return the completed form to the Bury Clarion C.C. Christine Duckworth,15 sunny Bower Street,Tottington,Bury,BL8 3HL with the appropriate fee.

·  Do not send cash.

·  Membership runs until 31st December 2015. Renewals must be sent before 1st March 2015.

·  If join after 1st September 2014 membership will run to 31st December 2015.

· 

Membership Type / Fee / Tick
Racing Senior / £15
Non-Racing Senior / £10
Junior (under 18) (D. of B. required above) / £6
Student Senior (full-time education over 18) / £10

I HEREBY DECLARE: That the particulars submitted on this form are complete and correct. I agree to abide by the rules of the National Clarion Cycling Club, which I have read and understand, during the course of my membership. (A copy of the rules is available on request and at www.clarioncc.org.)

I understand that participating in club activities is entirely at my own risk and that no liability shall attach to the National Clarion Cycling Club, club officials or members for any injury, loss or damage suffered.

Signed: Date:

The applicant’s signature is required for the application to be processed unless the applicant is under 18 years old when it must be signed by the applicant’s parent or guardian with their name printed underneath.

This form is valid to 31st August 2015.

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