Name: Male / Female Date of Birth
Address:
Post Code:
Tel: E-mail:
If you have an email address
please advise if you are happy to receive communications e.g. Club Newsletter
by email (helps keep club costs down).
Yes email is OK ¨
No only through the post ¨
Do you cycle for a) Leisure ¨ b) To Keep fit ¨ c) To Race ¨ d) Other (please state);
Have you been a member of another cycling club ? YES (name) NO ¨
Please state level of cycling experience; e.g. Newcomer / Raced at Cat 3 level.& list best Time Trial times if applicable:
Do you have any medical conditions (in case of emergency)?
For Insurance cover all Club Members MUST also apply for SC/BC membership .
Silver level membership is recommended by FBC as this covers riders
at all times (please ask for a form or check the FBC or SC website:
(www.FalkirkBC.co.uk/ www.scuonline.org/). A reduced
fee may be payable by new members in their
first year of BC membership (please ask).
Please enclose a cheque/ postal order made payable to: Falkirk Bicycle Club.
Total Fees Enclosed: (Signature)
..... Date
..
Parental/Guardian Consent (to be completed
if applicant is less than 18 years old)
I (name)
.. being the parent/guardian of the
above-mentioned applicant:
Understand and agree that my son/daughter participates in
events organised by the Club entirely at his/her own risk. I have considered
and understand the nature of such events and have discussed them with my
son/daughter. I am satisfied that my son/daughter is sufficiently responsible
and competent to assume full and entire responsibility for his/her own safety
whilst engaged in any event promoted or organised by the Club.
I Agree that my son/daughter shall participate in events
promoted or organised by the Club without any liability whatsoever on the part
of the promoter(s), organiser(s) or Club in respect of any injury, loss or
damage suffered by him/her, provided that this does not exclude the liability
of any such party for death or personal injury arising from that partys
negligence. I Confirm that my son/daughter does not have any disability or
medical condition, physical or mental, which could affect his/her ability to
ride safely.
Signed
(Parent/Guardian)
.
Date
.
Return completed form with payment to:
Ken Armstrong (01236
720152)
25
Cumbernauld
G67 2DA