MBMX Membership Form
Please complete the below form and then make payment at a club session
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Email *
Membership Type *
Member First Name *
Member Surname *
Member Date of Birth *
MM
/
DD
/
YYYY
Rider Gender *
Member Address *
Member Postcode *
Member / Parent / Guardian Phone Number *
Please enter a valid mobile or landline number beginning 01, 02 or 07
Please give details of any medical conditions
Do you consider yourself to have a disability *
The Disability Discrimination Act 1995 defines a disabled person as anyone with a "physical or mental impairment, which has a substantial andlong term negative effect on his or her ability to carry out normal daily activities"
If yes, please give details
Will Manchester BMX Club be your Primary club? *
Will you be a riding or non-riding member of Manchester BMX Club? *
Do you have a British Cycling racing membership *
What is your British Cycling licence number
If known, what is your transponder number(s)
Format should be 2 letters and dash and 5 numbers eg ZZ-99999. If you have multiple please separate with a colon
Emergency Contact Name *
Emergency Contact Relationship to Member *
Emergency Contact Number *
Please enter a valid mobile or landline number beginning 01, 02 or 07
Additional Parental Consent (for all riders under the age of 16) *
I give consent for my son/daughter's membership of Manchester BMX Club, I agree that my son/daughter will abide by the rules set out in both the Club's Constitution and the Code of Conduct, as will any parent/carer/family member attending. I also agree that Manchester BMX Club, it's Officials, Agents or Associates, have no liability for loss of property, accidents or injuries to my son/daughter however so caused. I agree to notify the Club of any medical condition that may effect my child's ability to safely participate in BMX events or training sessions. I further agree that in my absence, should my child require medical attention as a result of any injury sustained during a club activity, consent to treatment may be authorised by a club official.
Required
I confirm the above information is accurate and agree to abide by the rules of Manchester BMX Club *
Details of the club code of conduct can be found here http://www.manchesterbmx.co.uk/index.php/code-of-conduct
Required
If the rider is under 16, please provide the name of a parent or guardian
A copy of your responses will be emailed to the address you provided.
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