Clitheroe-Bike-Club-Membership-form1 by xiaoyounan

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									Clitheroe Bike Club Membership form

Name......................................................................................

D.O.B......................................................................................

Email (please write clearly).............................................................................

Home address
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
.......................Postcode..........................................................


 EMERGENCY INFORMATION
 CONTACT NAME:

 CONTACT NUMBER:

 ANY ALLERGIES/MEDICAL INFO:




       I have no medical condition that will prevent me from participating fully in the sport of cycling.

       I would like to be added to the CBC emailing list

Name..........................................................

Signature....................................................    Date......................................

(Of parent/guardian if under 18)

Please return to:                                                           Membership fees 2011:

Richard Paige                                                               Individual              £30
Page’s Farm                                                                 Family                  £40
Highmoor                                                                    Junior                  FREE
Clitheroe BB7 1PN

Cheques to Clitheroe Bike Club

								
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