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| Membership Form |
| Surname |
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| Christian Name |
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| Title |
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| Number/Road |
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| District |
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| Town/City |
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| County |
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| Country |
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| Post Code |
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| Land Line Number |
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| Mobile Number |
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| E-mail Address |
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| Section |
STOCKPORT |
| Official Position (if any) |
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| Date of Birth |
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| Type of Membership, please circle where appropriate |
Senior(18 and over), Junior, Juvenile, Non-Cycling/Social/Second Claim |
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£10 Senior first year membership, £20 Senior, £7 Non-cycling/Social/sec claim, £0 Junior, £0 Juvenile |
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Please return form to |
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Duncan McLaren, 3 Winifred Rd, Heaviley, Stockport, SK2 6HF |
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(0161 487 4828, 07725 341 334) |
I HEREBY DECLARE...
that the particulars submitted on this form are complete and correct. I agree to abide by the rules of the National Clarion Cycling Club during the course of my membership, (copies of rules available on request). I understand that participating in club activities is entirely at my own risk and that no liability shall attach to the National Clarion Cycling Club, club officials, or members, for any injury, loss or damage suffered. |
| Signed: |
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| Date: |
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