PROVISIONAL MEMBERSHIP APPLICATION FORM

Please return this form and payment (cheques made payable to South Wales Caving Club) to:

Sam Moore, Nant Lodge, Prestatyn Road, Prestatyn, LL19 9LD

PLEASE WRITE CLEARLY OR COMPLETE ELECTRONICALLY

Title:
Surname: / Forename(s):
Telephone:
(for address list) / House Name
or Number:
Alternate Telephone: / Address Line 2:
Email Address: / Address Line 3:
Postal Town:
Date of Birth:
(If under 18) / County:
Country:
Postcode:
Please give brief details of other caving clubs and caving experience:
Signed:
Parent/Guardian
Name:
(If under 18) / Parent/Guardian Signature:

The club has a clear non-discrimination policy but caving is a serious and potentially hazardous sport that requires both self reliance and team work in an unusual and sometimes challenging, environment. In order that we help you get the most out of caving please advise if you have any physical or learning difficulties that the club ought to be aware of that might compromise your safety and enjoyment, or that of those who may be accompanying you.

Data Protection Act

Your details are stored on a personal computer for administration and communication purposes.

Your details may be circulated to other club members via the club address list.

If you do not want your details stored and/or used in this way please tick this box.

Subscription fee calculation

The SWCC Provisional Membership subscription is £10, which covers you for a period of up to 12 months from joining. To this must be added the subscription for joining BCA, which providescompulsory caving insurance, unless you are already covered through another caving club or as a direct BCA member. If so, you must provide your BCA number and tell us the route. The BCA subscription depends on your date of joining: £17.00 in January-March, £12.75 in April-June, £8.50 in July-August and £21.25 after 1stSeptember (which covers the period up to 31st December in the year after you join). Full time students and those aged under 18 years pay a reduced BCA subscription – please contact me via the SWCC website if this is the case.

Total enclosed (please circle as appropriate): £10.00 SWCC only or £27.00 £22.75 £18.50 £31.25 with BCA

If your application is unsuccessful, your cheque will be returned.

(if appropriate) I declare that I have existing BCA membership and my BCA number is:
I am a BCA member via: / Signed:

(For SWCC Use: Date receivedDate accepted:)