Wetherby Wheelers

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Membership Application Form

I wish to apply for* / renew* membership for the year ending 31st August 2016

(Membership Year 1st September 2015 – 31st August 2016)

Surname ...... Date of Birth (If under 18) ......

First Names ......

Address ......

...... Post Code ......

Telephone No ...... Email address ………………………………………………..

Membership is available in the following six categories. The subscription fee for each of the first five categories includes full third-party insurance through the CTC. If you are already a full member of the CTC or BC (gold & silver card holders only), the fee is reduced by £26. (see Note 1 below)

Please tick the category which applies to you:

Membership Type / Amount / Please tick which applies / If already a CTC or BC member / Please tick if applicable
Senior (over 18) / £37 / £13 / See Note 1
Junior (16-18) / £26 / £4 / See Notes 1 & 2
Juvenile (under 16) / £26 / £4 / See Notes 1 & 2
Second Claim Member / £12 / £12 / See Note 3
Full-Time Student / £26 / £4 / See Notes 1 & 4
Social Member / £10 / n/a / See Note 5

Note 1: Please give your CTC or BC membership number if applicable…………………………..……

Note 2: Applicants under 18 must also submit a signed parental consent form.

Note 3: You must have CTC or BC membership through your first club that provides third party insurance for you whilst you are riding with our club.

Please give the name of your first claim club: ……………………...... ……….……

Note 4: Must be in higher education & living away from home.

Please give your university/college: ......

Note 5: Non-riding membership.

PLEASE ASK A MEMBER OF THE COMMITTEE IF YOU ARE UNSURE WHICH CATEGORY APPLIES

I enclose a cheque* / postal order* / cash* to the value of: £ ...... (* delete as appropriate)

OR I have paid by Bank Transfer the sum of: £………………………

Cheques to be made payable to “Wetherby Wheelers”

Payment can now be made by Bank Transfer (bank details below) but please still return the completed and signed membership form to the Club Treasurer.

NatWest, Sort Code: 60-21-13, Account No: 52149617 (Please quote your surname as the Ref.)

Signature ...... Date ......

Please return this form and the fee to the Club Treasurer:

Kathy Varley, 12 Ivy Lane, Boston Spa, WETHERBY, LS23 6PP, Tel: 01937 520 050