FROME AND DISTRICT WHEELERS

                                                                         APPLICATION FOR MEMBERSHIP

                                      NAME:                 ..........................................................................................................................................

                                      ADDRESS:           ..........................................................................................................................................

                                                                   ..........................................................................................................................................

                                      

                                      EMAIL:           ........................................................................................................

                               TELEPHONE:      .....................................................

                               DATE OF BIRTH (if under 18) ...............................

                I agree to take part in the club’s activities entirely at my own risk and without any liability whatsoever

               on the part of FROME & DISTRICT WHEELERS, its officials or members in respect of loss, injury

                or damage suffered, however caused.

                                      SIGNATURE.................................................................DATE....................................                           

                       (Personal data will be held on computer for Frome & District Wheelers official purposes only).

             I enclose subscription of:                £12 Family

                                                                                         (*Up to 2 adults and any number of children residing same address)

                                                                       £10 Senior

                                                                       £5.00 Junior or in full-time education

                                                                       £10 Second Claim

                                                        

                                      Cheques Payable to: Frome & District Wheelers

             If joining as 2nd Claim please state 1st Claim club...........................................................................................

            *Name of Family Member(s):

                                                           .....................................................................................................................

                             Are you a member of the CTC, British Cycling or any insurance company? YES/NO

               It is recommended that members consider obtaining accident and third party insurance.

              This can be obtained from either the Cyclists Touring Club (CTC), British Cycling or any

              insurance company of  their choice.

                               

              Parental Consent (To be completed in respect of all applicants aged under 18)

.

                       I ...................................................................................... being the Parent/Guardian of,

                       ..................................................................

              am happy that he/she is sufficiently responsible to participate safely in activities of the Club, including                riding on the public highway. I understand that he/she participates in the Club’s activities at his/her own

              risk and that he/she is solely responsible for negotiating the public roads. I am happy for him/her to

               become a member of Frome and District Wheelers.

              Signature: ............................................................................Dated: ...............................................................

                                                          Please return to:   FDW Secretary

                                                                                            Shaun Lambdin

                                                                                            57 Lydiard Way

                                                                                            Trowbridge

                                                                                            Wiltshire

                                                                                            BA14 0UW

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