NAME
ADDRESS
(inc postcode)
DOB / CATEGORY
HOME NO. / MOBILE No.
EMAIL
DATE OF PAYMENT / AMOUNT RECEIVED / £

PAYMENT & FEES

Please note that in addition to the annual membership fee all members are required to pay an additional fee of £1.00 per member for each rowing session unless you are a ‘working member’ of the boat safety crew or acting as a crew cox. The Club Treasurer collects these fees at each session. Any arrears are to be settled within a week upon notification.

Payment of membership fees can be made by cash, cheque (Mayflower Offshore Rowing Club) or via direct debit (form available from either the Club Treasurer or Membership Secretary).

Late payment of membership fees (due April 2011) beyond 4 weeks will result in an additional penalty fee of £15.

TERMS & CONDITIONS

In accordance with the Data Protection Act 1984 the Mayflower Offshore Rowing Club notify you that personal information provided in this membership application form will be kept on computer records. By applying to become a member you confirm that you have no objection. In accordance with the Act you will be asked to verify the details every year when you renew your membership.

I consent to my contact details (telephone and email) to be freely available to other Club Members in order to assist with internal communications regarding Club activities and events.

Telephone Email address

HEALTH & SAFETY

Upon acceptance into the membership of the Mayflower Offshore Rowing Club, I understand that rowing is undertaken at my own risk. I confirm that I do not suffer from any disability or medical condition which may render me unfit for strenuous exercise. Should a medical condition exist, this will not necessarily preclude you from membership/participation, but it must be declared on the Personal Information Sheet that each member has to complete on joining. Should you be in any doubt, advice should be sought from your family doctor.

I also confirm that I am able to swim a minimum of 50 metres.

I declare that the information in this application is correct to the best of my knowledge and belief. I agree to abide by the Club rules and constitution.

………………………………………………………………………………………………………………………………………………...……………..

Member Signature Date

EMERGENCY CONTACT DETAILS

NAME
RELATIONSHIP
ADDRESS
(inc postcode)
HOME TEL NO. / MOBILE TEL No.

EQUAL OPPORTUNITIES FORM

Please complete this section of the membership form to enable Mayflower Offshore Rowing Club to monitor its Equal Opportunities Policy. The information taken from this form will also assist the Club in identifying particular areas of need and determine what resources should be focused upon to ensure fairness to all.

The information you provide on this form may also be disclosed by the Club when providing data to support an application for grant funding as evidence of our commitment to and recognition of equal opportunities and anti-discriminatory practice.

AGE 18 - 44 / 45+ / SEX M / F
DISABILITIES / NO / YES (deaf, visually impaired, physical disability, learning disability, multiple disability, other)
ETHNIC ORIGIN / WHITE / BLACK CARIBBEAN
BLACK AFRICAN
BLACK OTHER / INDIAN SUB-CONTINENT / CHINESE – VIETNAMESE / OTHER ETHNIC GROUP (please specify)

MEMBERS SKILLS AUDIT

Please indicate any skill set/experiences you feel would be beneficial to the Club/members that you would be willing to share/contribute to the development of the Club/members.

MANAGEMENT & ADMINISTRATION / WATER SAFETY / BOAT MAINTENANCE / COACHING & TRAINING / OTHER

CLUB SUPPORT

All Club members are as a prerequisite of their membership required to actively assist with ongoing boat and Club House maintenance and housekeeping.

In addition, all members are strongly encouraged to take part with fund raising, social events and assisting the Club Committee.

Individual Membership Application Form Page 2 of 2