Membership & Racing Licence Application Form

Personal Details
Please provide the following personal details. Please complete in block capitals.
Surname
Forename
Title / Sex / Date of Birth
Address
Postcode
Daytime Telephone
Email
Club
(You may name up to 3 clubs but only the 1st will appear on your card)
Previous British Rowing Membership Number
(if applicable)
Equity Policy: British Rowing is committed to a policy of acting fairly in all aspects of rowing, and to providing a service to reach all communities. In order to assess our position, we need to monitor the numbers of people in our sport from different ethnic origins. It is also a condition of our grants from the Sports Council that we report on the ethnic backgrounds of our membership and also on the involvement of disabled persons within the sport. Please therefore complete the following, although it is optional and not compulsory. The information you provide will be used for statistical purposes only and will not be released to third parties in any way that will link the data with any identifying personal details.
Ethnic Origin (Please tick the most appropriate box):
White / Black or Black British / Mixed / Asian or Asian British / Other
British / Caribbean / White & Black Caribbean / Indian / Any other ethnic group
Irish / African / White & Black African / Pakistani
Other white background / Other Black background / White & Asian / Bangladeshi
Other mixed background / Chinese
Other Asian background
Disability:Do you consider yourself to have a disability?
Yes / No
If yes, what is the nature of your disability? / Deaf / Visually impaired
Physical disability / Learning disability
Sexual Orientation:I would describe myself as of the
following orientation
Lesbian/Gay/Homosexual / Heterosexual
Bisexual / Other
I do not wish to state
Membership Details
Please select the Membership category you require:

SilverGold Platinum

(with race licence) (Gold membership for life)
£28 (18 yrs & over) £53.50 Adult (18 yrs & over) £1100 (18 yrs & over)

£33 Student* (18 yrs & over)
£25.50 Junior (under 18 yrs on 1stSept 2015)
£16 Junior (under 14 years on 1stSept 2015)
RowHow subscription is included in all membership packages.
Silver: Civil and public liability insurance, Rowing & Regatta magazine (UK only), access to all the new activities with Explore Rowing, tours, training.
Gold: British Rowing competition race licence plus all Silver benefits.
Platinum: Life membership, British Rowing race licence, tie/scarf and all Gold benefits.
Members aged 80 or over may claim a £3 discount on the above rates. Please tick here if required:
* The discounted student rate is for 5 years maximum, full time students only.
Racing Licence Details
To help us make sure you can compete at the correct level please provide us with some information below. For guidance on completing this self-declaration please see the British Rowing website. If you would like any further information on the British Rowing points scheme please email
Please tick if you have ever competed outside England?
Please declare how many points you currently have in rowing and sculling / Rowing / Sculling
If you wish to regress please declare when your last win was in rowing and sculling / Rowing / Sculling
Please note: it is against the British Rowing Rules of Racing to misrepresent your rowing status (Rule 2-7-3a)
Payment Details
Credit/Debit Card / OR / Cheque / OR / Direct Debit
Please debit my credit/debit card:
Card Number:
______
Start Date: __/__ End Date: __/__
Issue Number: ___ / I enclose a cheque for
£______payable to British Rowing / I enclose a completed direct debit mandate.
You can download this form at:
Declaration
I declare that the details given above are correct and that I agree to abide by the rules of British Rowing Ltd.
Signed: ______Date:______
(Signature of parent/guardian if applicant is under 16)

Completed forms to be posted or faxed to: British Rowing, 6 Lower Mall, London W6 9DJ T: 020 8237 6700 F: 020 8237 6749

Email applications are not accepted. You should allow up to 10 days for receipt of your Racing Licence