Kidsgrove Wheelers
Cycling Club
Membership Application Form 1st January 2018 -31st December 2018.
Tick one box [ ] New member
[ ] Renewing member
Surname: ……………………….
First name: ………………………
Address: …………………………
…………………………
Postcode: ……………………………..
Date of Birth: ………………………..
Telephone No: ………………………
Email: …………………………
Health issues (not compulsory): ………………………….
Membership rates 2018 (tick requirements)
Junior (under 18 years) £ 5.00 [ ]
Senior £15.00 [ ]
Associate member £ 5.00 [ ]
Family membership up to 3 children £ 30.00 [ ] Optional
Total £
Please make sure you are insured via http://www.cyclinguk.org/membership or British Cycling at https://www.britishcycling.org.uk/membership See further details on Insurance Below:
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· Applicants please complete form, sign date and return to Angela Barratt with correct payment.
· Payment may be by cheque or cash, don’t send cash through the post.
· Download and print Membership and email to: or or hand to membership secretary on club night
INSURANCE:-
I do not need to pay the CTC Insurance Premium as I am insured as a member of the Cyclists’ Touring Club and/or British Cycling.
My CTC / British Cycling membership number is:-………………………………..
If you are not a member of either the CTC or British Cycling, Third Party CTC Insurance Premium is mandatory within the Kidsgrove Wheelers cycling club.
I acknowledge that the Club’s events will be held on the Public Highway and that I participate therein entirely at my own risk and that no liability whatsoever shall attach to the Club or any officials or members of the Club for any injury loss or damage suffered by me in or by reason of my participation in the Club’s activities however such may be caused and whether by negligence or otherwise. I further understandthat I must take full responsibility for the condition and roadworthiness of my cycle and the use of my cycle on the Public Highway in terms of speed and manner of riding commensurate withprevailing road conditions.
Parental consent (to be signed by a parent or guardian of members under the age of 18).
I………………………………..
Address……………………………………………………………………………………………………….
Being the parent of the above who was born on……………………
Hereby agree to him/her joining the Club subject to its rules and regulations.
I understandacknowledge and agree that the Club activities take place on the Public Highway and that my son/daughter participates therein entirely at their own risk and that no liability whatsoever shall be attached to the Club or any officials or members of the Club for any injury loss or damage suffered by my son/daughter in or by reason of the activity however such may be caused and whether by negligence or otherwise.
I further understand and agree and accept responsibility for the roadworthiness of my son/daughter’s cycle rests with me and my son/daughter only and thatI and they take full responsibility for their use of the cycle on the Public Highway commensurate with the conditions then prevailing. I am satisfied that my son/daughter is sufficiently responsible and experienced to assume full and entire responsibility for his/her own conduct and safety whilst engaged in Club activities on the Public Highway.
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Signed:
Dated:
Membership for the forthcoming year will run from 1st January 2018 to 31st December 2018. Applications received from ‘new members only’ between 31st October 2018 and 31st December 2018 shall pay the appropriate subscription and this will hold good for the following year also.