Holme Valley Wheelers 2017 Membership Appilcation Form
To become a member of Holme Valley Wheelers for 2017, please complete this form and click 'Submit'.

Please then send the appropriate membership fee, to club treasurer (details below):

Mrs Jacqueline Haigh
75 Hall Ing Lane
Honley
Holmfirth
West Yorkshire.
HD9 6QW

Tel:- 01484 665 682


Cheques should be made payable to “Holme Valley Wheelers”

The membership rates for 2016 are:

All Senior members (full,second claim and social) £10.00
All Junior members (full,second claim and social) £5.00
(Junior membership applies to persons under 18 years of age)

If you joined after 30th September 2016, your membership will continue to the end of 2017, without any further payment. You will need to confirm that the information that you provided has not changed, provide updated information where appropriate and in all cases advise on the 3rd party liability insurance cover, for cycling as required below.

Members who do not renew their membership by the date of the 2016 AGM (1st March 2016), will be deemed to have left the club.

If you have any queries regarding completing this form please contact Jacqueline Haigh 01484 665 682.

Personal Details
Surname
Your answer
First Name(s)
Your answer
Date of Birth
dd/mm/yy
Your answer
Gender
Address
Your answer
Telephone Home
Your answer
Telephone Mobile
Your answer
Email Address
Your answer
School Attended (18 and under only)
Your answer
3rd Party Liability Insurance
The club's constitution requires that all riding members must have 3rd party liability insurance, issued by one of the 3 organisations listed below. It will be necessary to confirm insurance details, before accepting renewal of membership. The treasurer will not bank cash or cheques until we have all of the information needed. Non riding social members do not need to have 3rd party liability insurance. Please select your insurance provider from the list below:
What membership type are you applying for?
My BC/CTC/TE membership number is:
Your answer
My BC/CTC/TE membership expiry date is:
dd/mm/yy
Your answer
Next of Kin Details (in case of emergency)
Name
Your answer
Address
Your answer
Telephone
Your answer
Communications
Please use the box below for any comments you would like to make about the club:
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms