Contact Information Membership Application Form The Velo Club

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					                              The Velo Club Godalming and Haslemere
                                  ("VC Godalming + Haslemere")
                                        Membership Application Form                                           page 1 of 2

Please read and complete this membership application form. Once complete please submit by email by clicking on the 'Submit
by Email' button and then print and sign the whole form and return to the membership secretary.

We have a legal duty to protect any personal information we collect from you. To facilitate administration, VC Godalming +
Haslemere wish to store this information on a computer database. The information you provide on this form is for use by
VC Godalming + Haslemere. It may be forwarded to other parties for the purposes of insurance. In accordance with the
Data Protection Act 1998 VC Godalming + Haslemere agrees not use this information for any other purpose.




Contact Information
'*'s designates mandatory fields




Date *

Title *                                       First or Given name *

Last name *

Address 1 *

Address 2

Town *

County *

Post Code *

                                            You must eighteen or over to become a member of VC Godalming + Haslemere
Date of Birth                               however you may be eligible to join Club Rides before then. Please
                                            look on our website for further information www.vcgh.co.uk


Email address *

Website Username *

Mobile *

Home Phone *

Work Phone


Main Ride Type(s)            off road            road            both
Occupation




                                        The Velo Club Godalming and Haslemere Limited
                                                       www.vcgh.co.uk
                                            email membership@vcgodalming.co.uk

                                                Registered number: 6047519
                          The Velo Club Godalming and Haslemere
                              ("VC Godalming + Haslemere")
                               Membership Application Form                                                         page 2 of 2


Emergency Contact Information
Contact 1

First or Given name *                                                 Last name *

Telephone *                                                           Relationship *

Contact 2

First name *                                                          Last name *

Telephone *                                                           Relationship *


Annual membership is currently £15 per annum. Please make your cheque payable to `VC Godalming + Haslemere'



Agreement:
I am aged 18 or over. I support the objects of VC Godalming + Haslemere. I understand that VC Godalming + Haslemere is
a voluntary organisation and I agree to help with VC Godalming + Haslemere's activities. I have read, understood and agree
to be bound by VC Godalming + Haslemere's memorandum, articles of association and Rules, the highway code and
applicable laws. In particular, I undertake to give a guarantee in a sum not to exceed £1 in accordance with clause 6 of VC
Godalming + Haslemere's memorandum.

I acknowledge that cycling both on and off road, is an activity with a risk of personal injury or death. My decision to
voluntarily participate in the activities of the Club is an informed decision and I am aware of and shall accept such risks. I
agree to be responsible for my own actions and involvement in the activities of the Club.

Signature of Applicant




Please make your cheque payable to `VC Godalming + Haslemere' (with `membership' and your name in full written on the back).
Send payment with your completed form to:
                                   VC Godalming + Haslemere Membership Secretary,
                               c/o Alice House, Khartoum Road, Witley, Surrey GU8 5RB




                                                                                                             Print Form




                                          The Velo Club Godalming and Haslemere Limited
                                                          www.vcgh.co.uk
                                              email membership@vcgodalming.co.uk

                                                  Registered number: 6047519