LEAMINGTON CYCLING & ATHLETICS CLUB

Affiliated for Competition to EA, WCAA, CTT, BC & BTA

APPLICATION FOR MEMBERSHIP

Name:
Address:
Postcode: / Tel: /

Mob:

Date of Birth: / Place of Birth:
e-mail Address:
Athletic/Cycling interests:
Emergency Contact Name:
Address:
Relationship: / Tel:

Club Membership Is Open To All Groups of The Community.

*I am not currently a member of an athletics/cycling club affiliated to the UK Governing Bodies of these sports, (or)

*I am/*was a member of ………………………………………………, being a Club(s) subject through affiliation to the jurisdiction of the *Athletics/*Cycling Governing Bodies within UK & Northern Ireland,

*but ceased to be a member on ………………….(date),

and would like to become a member of the Leamington Cycling & Athletics Club for the period from today’s date until the end of the Club subscription year on 31st December ………. .

*I am eligible to compete as defined by British Cycling and UK Athletics, / *I wish to be an Associate non-competing member, and agree to abide by the Club Rules.

(*delete as appropriate),

I enclose the sum of £ ………… as my subscription to cover the period of membership and understand that continued membership will be subject to payment of further subscriptions as set out overleaf.

Please note: You are responsible for notifying the Club and your Coach of any medical condition which could affect your participation in any event or organised training session.
Signed:
………………………………………………
(Parent or Guardian if under 18 years old)
…………………………………………………… / Date:
……………………………………………….
An Application by an under 18 will not be accepted without a completed Parental Consent Form which will be passed to your Coach & Club Child Protection Officer.
Name of Coach………………………………
Send your membership application with a cheque made out to Leamington C&AC to,
John Pitman, 4 Cobham Green, Whitnash, Leamington Spa CV312TH
Tel 01926 332116 e-mail –

Leamington C&AC is an Equal Opportunities Club. Applications which contravene the Rules of the Governing Bodies of Athletics or Cycling may however be refused and subscriptions returned.

Annual Membership runs from 1st January: The Subscription fees payable each year are shown overleaf:

Annual Membership:

LC&AC Subscriptions remain low because Seniors and Parents of Young Members volunteer to help as officials, coaches, event organisers, course markers, marshals and refreshments providers, giving their time free of charge. With over 200 Members, just a minimum assistance of two hours each per year can make all the difference, so you are expectedto contribute to that voluntary workforce.

Subscription Fees, payable annually on 1st January:

Full Membership: £30.00.

Juniors ( 16 and 17) and Juveniles (under 16) £22.

Second Claim fee (for cyclists with First Claim to another Club): £30.

The above fees cover the CTT levy of £2 on all club TT’s ridden.

Current BC or LVRC Cycle Race Licence Fees payable separately.

Non-racing members (All ages): £5

The Subscription payable may be reduced in accordance with Club Rule 6g if you become a member for the first time after 1st October. It may also be possible to arrange a reduction if you are dependent on some form of state benefit. In either event please contact the Membership Secretary who will consider the circumstance on a case by case basis.

Club clothing is available from.

Andy Gibson, 8 South View Road Leamington Spa CV32 7JD. 01926 832851

Leamington C & AC is an Equal Opportunities Club

AmendedMarch 2013