CYCLE CLUB BEXLEY

APPLICATION FOR MEMBERSHIP

Surname (Mr., Mrs. or Miss) ………………………………………………………….

Christian Names ………………………………………………………….

Address ………………………………………………………….

………………………………………………………….

………………………………………………………….

Post Code ……………………………

Telephone No. ……………………………

Date of Birth ……………………………

I hereby apply for election to membership of the Cycle Club Bexley and, if elected, agree to abide by the rules and by-laws of the club.

Signed …………….……………………………

Date ……………………………………………

I support this application for membership and confirm that the above details are correct. I understand and agree that neither the officers or members of the Cycle Club Bexley shall be held responsible for any accident or loss sustained by the applicant in the course of his or her cycling club activities.

………………………………Parent/Gardian

Date …………………………………………

PROPOSER…………………………………..….SECONDER………………………………………

Committee Decision ……………………………………………. Date ……………………………