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membership form - _MEMBERSHIP APPLICATION_


									                                                                                  Tel/Fax: 011 314 4628
                                                                                  P O Box 7337, Halfway House 1685
                                                                         • email:

                                             MEMBERSHIP APPLICATION
Membership type                    Principal                   Family               Junior (min 12 yrs)             Honorary Life

Please complete in block letters
                                                                                                 Chip Nos

                                                                                                                               ship type
        Surname                    First Name                      ID No                  Winning        Champion
                                                                                           Time            Chip

Postal address:
                                                                                                      Postal code:

Physical address:
                                                                                                      Postal code:

Tel No – Home:                                                        Tel No – Work:

Cellular No:                                                          Email address:

Fax No:

Medical Aid:                                                          Medical Aid No:
                                                                      Emergency Contact Tel
Emergency Contact Person:

Membership of MCC is granted on the distinct condition that neither MCC, nor any office bearers of the Club, accepts responsibility for
any injury or illness sustained or suffered by any person or for any theft or loss or damage to any property occurring during Club outings
or activities, however caused, and whether due to the negligence of the Club or any of its office bearers or arising in any other manner
or from any other cause whatsoever. The applicant undertakes to acquaint him/herself full with the Club’s Constitution.

Signature:          ______________________________________________________                             Date: ______________________

Parent/Guardian (if under 18) ______________________________________________                           Date: ______________________

                                                                                            Receipt to be returned to new member

_____________________________________________________- has been granted membership of MCC.

                                                                                            (Committee Member’s signature)
PAID:     R__________________________

Sunday Road rides:            from the Club, Plot 210, 35 Austin Road, Glen Austin, Midrand
                              Times: 1 September to 31 April (summer)           07h00
                                        1 May to 31 August (winter)             07h30

Saturday MTB rides:           from Mugg & Bean, Carlswald Lifestyle Centre
                              Times: 1 September to 31 April (summer)             06h00
                                       1 May to 31 August (winter)                06h30

                                                                                                                       (Please turn over)

Admin Fee              R                                                      Paid             R
Annual subscription    R                  Per full member                     Paid             R
Annual subscription    R                  Per active family member

Annual subscription    R                  Per in-active family member         Paid             R

Annual subscription    R                  Per junior member (12-18)           Paid             R

                                                                              TOTAL PAID       R

        All applicants must be able to ride a bicycle with total confidence and must be able to cover a
        distance of 30kms with ease.
        Bicycles must be in good condition with emphasis on brakes, tyres, deraileurs and jockey.
        A puncture repair kit or spare tube, a good pump and plastic water bottle to be carried on each ride.
        Head protection in the form of a hard helmet is required. No Helmet, No Ride.
        Advice on care and condition of bicycle will be given on request.
        Efforts will be made to ensure no rider gets abandoned on a ride due to tyre failure, a fall or an
        Minimum age for a Junior member is 12 years.

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