Membership Application Form

 

Name:

 

Address:

 

 

 

 

 

 

Telephone:

 

e-mail:

 

Date of Birth:

 

Tick if you do NOT want your address circulated to other members:  o

 

Membership required

 

ü

Juvenile/Junior (under 18)

£3.50

 

Senior (18 or over)

£10.00

 

Family (2 snr. + all jnrs at same address)

£14.00

 

Second claim

(jnr. £3, snr. £6, family £10)

 

 

Family Membership Only

Names

 

Dates of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

I/we wish to join Leeds Mercury Cycling Club and agree to abide by the rules of the club.

 

  

Signature: …………………………………………...             Date:  ………………

 Please print and return the completed form to: Alistair Cameron, 40 Narrowboat Wharfe, Rodley, Leeds LS13 1RE  with the appropriate payment, cheques made payable to Leeds Mercury CC, thanks.
   
   
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