Wyedean Canoe Club

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					                               Wyedean Canoe Club
  Membership for the year 1st April 2010 to 31st March 2011
                                                       Please complete and return this form to
     Membership Type (please tick)
                                                       the Membership Secretary:
Junior/Student/OAP               £30.00                Wyedean Canoe Club
                                                       c/o 1 Barrowell Lane
Single Adult                     £35.00                St Briavels
Family                           £45.00                LYDNEY
                                                       Gloucestershire
Social                           £20.00                GL15 6TP
    Please make cheques payable to                     Tel: 01594 530994
       ‘WYEDEAN CANOE CLUB’                            E-mail: wyedeancanoeclub@btinternet.com
                                                  If you are a                               Qualifications and/or
                  Name(s)                         member of                                  interests (please tick)
                                                 BCU/WCA/SC       Date of
                                                    A please       Birth




                                                                                                                                          White Water
                                                                                                                             Open Canoe
                                                                                  Marathon



                                                                                                       Sea Kayak




                                                                                                                                                        Coaching
                                                                                                                   Surfing
                                                                                              Slalom
     First Name               Surname                include
                                                 membership
                                                    number




    Address



      Town
    County                                        Telephone No
  Post Code                                       Mobile No
     E-mail
                        Preferred means of correspondence (please tick)    E-mail                                   Post
DATE OF BIRTH: In a change from previous years please provide date of birth for all potential
members; we have been asked recently to compile a number of age related statistics when applying
for grants or submitting returns to Sport England which has been difficult without full information.
PAYMENT: Membership money should only be handed to the person on bank duty at the river on
Thursday evenings or to the Membership Secretary. If neither of these people is available, then
please post your membership to the Membership Secretary at the address above.
DECLARATION: I agree to abide by the club rules and guidelines and understand that canoeing is a
risk sport and that Wyedean Canoe Club cannot be held responsible in any way for any loss, damage
or injury to persons or property. I do not have a criminal conviction which is as defined by the
Rehabilitation and Offenders Act 1974.
DATA PROTECTION ACT: I agree to my details being kept on a database for club use only and for my
phone number to appear on a membership list to be circulated to Club Members unless otherwise
requested by myself in writing.
Signed (by parent or guardian if member is under 18 years):               Date:

				
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