Adult Subscription Form – Kings Lynn Cycling Club

Part 1 - About You

Your Name *

First

Last

Your Gender *

Date of Birth *//

Your Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Your Telephone Number *

Your Mobile Phone Number *

Your Email *

Email

Confirm Email

Are you already a member of any other cycle clubs? *

Yes
No

Please select "yes" if you are already a member of another cycling club. If not please select "No"

Emergency/Next of Kin Name *

First

Last

In case of an emergency, please enter the name of your next of kin.

Emergncy/ Next of kin Telephone Number *

Please enter the corresponding telephone number of your next of kin.

Part 2 - Subscription Fees

Price per adult:

Price: £ 15.00

Are you paying by Cheque or Bank Transfer (BACS)? *

Cheque
BACS

Would you like a copy of the "Cycling Time Trials" (CTT) handbook? - £15.00 (P&P included) *

YES I would like a copy of the CTT handbook
NO I would not like a copy

If you would like a copy of the Cycling Time Trials (CTT) handbook. Please select "Yes". If not select "No". Prices include P&P.

Would you like a copy of the "Cycling Time Trials" (CTT) East District handbook? - £3.00 *

YES I would like a copy of the East District CTT
NO I would NOT like a copy

Voluntary financial contribution *

Yes I would
No thanks

Would you like to make a voluntary financial contribution to the club? If so click "Yes, otherwise click "No".

Annual subscription fee - Total:

£ 0.00

This is the total amount required for your chosen membership subscription.

Part Three - Consent

Please read and observe the following options carefully.

I hereby consent that the information provided on this form can be held by Kings Lynn Cycle Club for the duration of my membership of the club. *

I consent
I do not consent

I consent to be contacted by electronic mail (e-mail). *

I consent
I do not concent

I understand that should I join the KLCC Facebook group that I may be receive communications through this social media. *

I consent
I do not consent

I consent that appropriate photographs and videos recorded during club activities may be used in club publicity. *

I consent
I do not consent

I consent in the event of an incident during club activities the emergency contact provided may be contacted. *

I consent
I do not consent

Terms of Service *

I agree to the terms of service.

I will abide by the Club's constitution, club rules, code of conduct, disciplinary policy, equity policy, social networking and child welfare policy. I understand that if the above named member does not also abide by these rules / codes of conduct / policies that the club may take disciplinary action.