If you wish to join then please complete this form and submit it. We will get back to you as quickly as we can. We will also then provide you with the payment options. Note: fields marked with a * are required entries.

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Name *

First

Middle

Last

Address (line 1) *

Address (line 2)

Town/City *

Post Code *

Date of Birth *

Allows membership category to be validated and also useful for event entries.

Email *

Email

Confirm Email

This will be used as your primary contact method.

Telephone

Optional but very useful. Normally please supply a mobile number.

Emergency contact number

This is optional but very useful in case help is needed during a club event or ride.

Individual membership required: *Senior (£10)Junior – under 18 years (£5)Juvenile – under 16 years (£5)Second claim (£5)Under 12 years (Free)

Please choose the type of membership you require from the available choices.

I have read, understood, and agree to abide by the club rules and safeguarding policy as well as traffic laws and Highway Code when supporting or participating in any club activities or events. — I confirm that there are no relevant personal circumstances, such as health conditions, criminal convictions, disciplinary actions or conflicts of interest, that could affect my ability to participate safely, meet membership requirements, or comply with club rules. — I acknowledge that if I choose to take on additional responsibilities in the future it may be necessary to carry out formal checks e.g. use of the Disclosure and Barring Service. — I understand that the club committee may terminate my membership if I breach the club rules or my conduct is unseemly. — I declare that the information provided in this application is true and correct to the best of my knowledge. — I agree to pay the required membership fees and any other charges associated with my membership. — I consent to my personal data being stored and processed by the club in accordance with the club's data policy. — I agree to provide proof of my identity and address to a member of the club committee before my membership can be confirmed. *

• I confirm my agreement

Please ensure you understand this list of conditions so that your application can be progressed.

Notes / questions

If you have any specific information or questions you wish to add then you can include them here. Alternatively send us a separate email to secretary@wolseyroadclub.co.uk .

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