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CAITHNESS CYCLING CLUB
MEMBERSHIP FORM
2004 |
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SURNAME |
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FORENAMES |
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ADDRESS |
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TELEPHONE |
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HOME |
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MOBILE |
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E-MAIL |
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DATE OF BIRTH |
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CATEGORY |
TICK |
FEE |
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YOUTH
JUNIOR
SENIOR
VETERAN
* FAMILY
STUDENT |
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£5 |
12Years old and up to the age of 15 and those 16 year olds
whose 16th birthday falls within the current season. |
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£10 |
Whose 17th or 18th birthday falls within the current
racing season. |
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£17 |
40+
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SCU |
CTC |
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£17 |
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£22 |
Please tick if a member of the above organisations. |
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£10 |
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INSURANCE |
£10 |
Any member wishing to do Time Trials must have Insurance.
3rd party insurance is available from the CTC through the club please tick
box if required. |
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TOTAL |
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*
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Please enter below other names to be included in family
membership including date of birth. |
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Tick box if insurance is required. |
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I understand that taking part in club events which is held
on the public highway I participate therein entirely at my own risk and
that no liability whatever shall attach to the club or any officials of
the club or any member of the club for any injury loss or damage suffered
by me in or by reason of the event however such may be caused and whether
by negligence or otherwise. |
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SIGNATURE |
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DATE |
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Persons under the age of 18 years old must
have this signed by Parent/Guardian. |
