NORTH BUCKS ROAD CLUB

MEMBERSHIP APPLICATION/RENEWAL 2015

Membership Subscriptions (including second claim applications) for the calendar year 2015 are as follows:

Membership Type / 1st Claim(£) / 2nd Claim(£)
Seniors / 22.00 / 16.00
Juniors (16 or 17 on 1st Jan 2015) / 3.00 / 3.00
Juveniles (under 16 on 1st Jan 2015) / 3.00 / 3.00
65 years and over on 1st Jan 2015 / 16.00 / 16.00
Family (Spouses/Partners and Children) / 29.00 / N/A

All members wishing to renew their Subscriptions are advised that payment should be made no later than 28th February 2015. Failure to meet this requirement could seriously affect your ability to enter events under the club name.

Please send your completed form together with payments to the Membership Secretary:

David Price, 14 Braybrooke Drive, Furzton, Milton Keynes,

Bucks, MK4 1AF

Cheques to be made payable to: ‘NORTH BUCKS ROAD CLUB’

Part A should be completed for membership renewals.

Parts A and B should be completed for new applications for membership.

PART A

Name(s) Mr/Mrs/Miss
Date(s) of birth
Membership Type (1st claim/ 2nd claim)
If applying for 2nd claim membership please state the name of your 1st claim club
Category(Senior/Junior/Juvenile/65plus/Family)
Address
Telephone / Mobile
E-Mail Address / Preferred method of contact(E mail/Post)

The Club Newsletter is available on the web site if you would like to receive your newsletter via post, please tick here The newsletter is infrequently published: the website is the best route for club news.

Signature______Date______

PART B

I wish to apply for membership of the North Bucks Road Club (appropriate fee enclosed).

I understand that my application is subject to the approval of the committee and that should I be successful in my application, I agree to the following:

To abide by the rules and regulations of the North Bucks Road Club

To provide assistance at Club events at the discretion of the organiser of that event.

Signature______Date______

Proposer (Club Member)______

Seconder (Club Member)______

The North Bucks Road Club recommends wearing an approved hardshell helmet when racing and on club runs. We also recommend that members have third party insurance through membership of the CTC or British Cycling.