Coalville Wheelers Cycling Club
Membership Application 2018
(You can also join on-line via www.britishcycling.org.uk, slightly cheaper fee)
Declaration
I wish to join/renew my membership with the Coalville Wheelers Cycling Club, (the Club) and agree to abide by the Club Rules and Constitution and to conduct myself at all times in such a way as not to discredit the Club’s name and reputation.
I agree that I partake in all Club activities at my own risk.
Any personal information provided to the Club will be used solely by the Club to maintain our membership records and for communicating information to members. We will not disclose any personal information to any other third parties, unless required to do so by law. Personal details will be held on the Club's membership database.
Photographs are regularly taken at club activities / race events and used / posted for club promotion on our Facebook pages, website, in the media and so on. Please advise the Membership Secretary () of any objection to photographs of you / your child being used in this way. This is particularly important for those under 18.
All applications from under 18s and Vulnerable Adults (including those within Family applications) are subject to our Safeguarding and Protecting Children / Vulnerable Adults Policies (available on our website - www.coalvillewheelers.org.uk.).
All completed applications are considered by the Membership Secretary / Club Committee on receipt along with the annual subscription fee. If declined, no reason need be given by the club, although monies received will be refunded in full.
No refund will be given for membership cancellation, after this has been accepted.
Membership becomes renewable 1st of January each year
(Indicate membership applicable)
Senior / £30 / Second Claim / £15Junior / Juvenile (12 to 17) / £10 / Day membership / £1
Family (provide details of all) / £40
Pay electronically by BACS or annual standing order: A/C No. 34680660 Sort Code 30-64-18. Use your name as the Reference please.
Cheques payable to: Coalville Wheelers Cycling Club.
Applicant’s Name:
Signed: Date:
Address:
Telephone Number: Mobile Number:
Email address:
Date of Birth: Age:
Emergency Contact Name: Phone:
I am already a member of the following cycling club(s):
If you are or have been suspended by any cycling club or organisation, please provide details:
SIGNATURE OF PARENT OR GUARDIAN FOR UNDER 18 YEAR OLD AND VULNERABLE ADULTS APPLICANTS
Print Name: Signed: Email address:
FAMILY MEMBERSHIP ONLY (Children 18+ should apply for senior membership)
Family member details:
1) Name:
Date of birth:
2) Name:
Date of birth:
3) Name:
Date of birth:
4) Name:
Date of birth:
Return to: Alan Vallance:-
1. or
2. or
3. 4 Forest Rise, Desford, Leicester LE9 9DX (in case of query, ring Alan on 07880 780508)