Dyfed Dirt Bike Club
Clwb Beic Modur Dyfed
APPLICATION FOR MEMBERSHIP 2010
Please complete using block capitals.
Surname __________________________ Male/Female *
First Name __________________________ Adult/Junior *(under 16 on 1st Jan)
Address __________________________ DOB Juniors Only _________
Post Code ____________
Tel No. ____________
Main interest _____________________________ e.g. enduro, MX, quads etc.
I herby apply to join/renew membership of* the above club. £5.00 for all members.
I agree to abide by the rules and regulations of the club and declare that I participate in all
club activities entirely at my own risk.
I enclose my current membership fee (cheques made payable to Dyfed Dirt Bike Club).
(* delete as necessary)
Signed ____________________________ Date _______________
Return membership forms with fees to club secretary; (include SAE for return of
Jon Stobbs, Rhyd-y-Fantwn,Moylegrove,Cardigan,Pembs,SA43 3BL.
This club is affiliated to the Auto Cycle Union (ACU).