Holme Valley Wheelers 2019 Membership Application Form
To become a member of Holme Valley Wheelers for 2019, 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 2019 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 2018, your membership will continue to the end of 2019, 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 2019 AGM (5th February 2019), will be deemed to have left the club.

If you have any queries regarding completing this form please contact Jacqueline Haigh 01484 665 682.
Email address *
Personal Details
Surname *
First Name(s) *
Date of Birth *
dd/mm/yy
Gender *
Address *
Telephone Home
Telephone Mobile
Email Address
School Attended (18 and under only)
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 / Cycling UK (formerly CTC) / TE membership number is:
My BC / Cycling UK (formerly CTC) / TE membership expiry date is:
dd/mm/yy
Next of Kin Details (in case of emergency)
Name *
Address *
Telephone *
Please use the box below for any comments you would like to make about the club.
Declaration
The club store personal data for membership purposes and conducting club business. By submitting this form, I consent to the club holding my data.
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