MEMBERSHIP APPLICATION

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Welcome to the Over 55 Cycling Club (Inc).
We hope that you will enjoy cycling in our company on the regular rides that are organised by our committee.

PARTICIPATION STATEMENT: The Over 55 Cycling Club (Inc.) recognises that cycling is an activity that can be dangerous and can result in injury, on even death. Member's of the Club must accept the risk of their involvement in Club activities and are responsible for their own actions and safety.

The majority of our rides are conducted on the many cycle tracks around the metropolitan area. It is unavoidable,however, that some rides or sections of rides, must make use of roads.. There are grades of rides to suit different riding capacities.

Signature:

Witness:

Date:

Personal Details: FAMILY NAME (Block letters):  Telephone:

Given Name:   Preferred Name(for badge):

Email:   Date of birth:

POSTAL ADDRESS:

Emergency Contacts: Please give TWO emergency contacts. If possible one of the contacts should be on a mobile number.

1: Name:   home address:

1: home telephone:   mobile:


2: Name:   home address:

2: home telephone:   mobile:
Office Use Only: Membership approved as

subscription received     Regular member     Social member     Recorded     Date