Chelmsford Mountaineering Club
Application Form for Affiliate Membership
Completion of this form and acceptance as an affiliate member of the CMC does not constitute full membership. An induction (including payment of fee) would be required to become a full member.
I (full name) ______*
of (address) ______*
______*
______*
Post Code ______* Date of Birth : ______*
Apply for affiliate membership of the Chelmsford Mountaineering Club,
during the period of to .
I acknowledge the Club's Constitution and rules and agree to be bound by them.
The following information is requested to assist with the administration of the club.
Home Phone ______Mobile ______
I accept that climbing and mountaineering are activities with a danger of personal injury or death. I am aware of and shall accept these risks and wish to participate in these activities voluntarily and shall be responsible for my own actions and involvement.
Signed: ______Date: ______
Next Of KinName:Relationship:
Contact 1,Address:
Contact (landline):Contact (mobile):
Next Of KinName:Relationship:
Contact 2,Address:
Contact (landline):Contact (mobile):
I (members name) ______as sponsoring member, agree to be held responsible for the safety and behaviour of my guest, whilst an affiliate member of the Chelmsford Mountaineering Club, and to ensure that constitution and rules of the club are adhered to at all times.
Signed: ______Date: ______
Membership ( £5.00 ) Paid / Unpaid. Membership paid to ______
Signature of collecting officer ______
* Some information will be supplied to The British Mountaineering Council (BMC) for the administration of membership, The BMC will not use this information for any other purpose other than those associated with the membership of the BMC. CMC will hold this information on the club database and it may be disclosed to other club members as required in the running of the club.
Chelmsford Mountaineering Club
Application Form for Club Membership
Members name: ______
Climbing experience. UK
Please give details of areas visited, grades climbed, if competent leader / seconder. Some of your favourite routes.
Climbing experience Alpine / Aboard.
Please state areas visited, Mountains or Routes climbed.
Do you have any medical conditions/ illnesses that may affect your health whilst climbing or walking. It is your responsibility to inform one of the club officers should any medical conditions become known or change.( This information will be held in the strictest of confidence)
Members signature ______Date:______