2021 Membership form
Membership year 1st January – 31st December.
Please read and complete applicable fields, making relevant payment. MEMBERSHIP IS NOT VALID UNTIL PAYMENT IS MADE.
Email *
Name *
Gender *
Date of birth *
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Age at 1st January 2021 *
Email *
Address *
Phone number *
Membership: Junior (under 16) — £8 Senior — £12 Family — £22 *
Additional information for Family Membership
First additional name
Date of birth
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DD
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YYYY
Gender
Clear selection
Second additional name
Date of birth
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DD
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YYYY
Gender
Clear selection
Third additional name
Date of birth
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YYYY
Gender
Clear selection
Fourth additional name
Date of birth
MM
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DD
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YYYY
Gender
Clear selection
Are there any disabilities, allergies or medical conditions we need to be aware of? If yes what? Please list any medications and if they self-administer or need help.
Contact details in the event of an emergency
Name *
Telephone number *
Relationship *
Is there anything else we need to know about your child’s safeguarding? If yes, what?
Declaration
I have accurately completed the above details in order to be a member of Ipswich BMX Club until 31/12/2021. *
Name *
Date *
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DD
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Please add me to the IBMXC Facebook Messenger Page. My Facebook name is:
Declarations and Waivers

By submitting this Application, you agree that you understand that BMX racing carries a risk of injury. The
club, its servants, agents and employees will take responsible precautions but are not under any liability
whatsoever for the loss of property, accidents or injuries to members, however caused.
Protective Clothing: During Club sessions the minimum requirements are for the wearing of a full-face helmet,
full finger gloves and covered legs and arms.
Data Protection: Your details will be held on a permanent basis in accordance with the Data Protection Act
1998 and for the purposes of British Cycling membership, and your details will be shared with the British Cycling
Federation. However, the information remains confidential and will not be shared with or sold to a third party. Ipswich
BMX Club is affiliated to British Cycling and adheres to the Child Protection Policy laid out by the British Cycling
Federation. If you would like to review what information we hold about you, please request a copy of your data record
by emailing ipswichbmx@gmail.com. All such requests will be responded to within 14 days.

Photographic Consent: To comply with the Data Protection Act 1998, we need your permission to use photographs and video recordings. please tick yes box if this is acceptable. *
Payment Details
BY PAYPAL (preferred method) By Bank Transfer
If you are renewing membership, and we already have
your email address, we will send you a renewal email.
It would be really helpful if you could use this method of
payment, to simplify the admin process. Thank you.
https://www.PayPal.com/paypalme/IBMXClubFundraiser
Bank BARCLAYS BANK
Branch Princes Street, Ipswich
Acct Name Ipswich BMX Club
Sort Code 20-44-51
Account No. 23710173
Please include your Name and add Membership as
reference with any payment method
If you need to use cash or cheque, both are still acceptable, but we would prefer it if you could use one of the above
electronic payment methods if possible. Thank you.
Code of conduct
As a volunteer organisation dedicated to promoting the sport of BMX racing, we encourage good behaviour and
sporting respect from all members, riders, parents, supporters and officials at all times and expect them to abide by
our Code of Conduct. The full Code of Conduct is available on request from the Club Secretary. Anyone found to be
in breach of the Code may be asked to leave the session by a club representative and, after committee consultation,
they or any associated member may be asked to leave the club. Any such incident may be notified to British Cycling.
The following keys points from the Code of Conduct apply to all members, riders, parents, supporters and officials
and anyone else engaged in the club's activities:
• All persons must conduct themselves in such a manner as to reflect the ideals of good sportsmanship and
avoid any conduct which may bring their self, the club or the sport of BMX into disrepute.
• All persons must respect the rights, dignity and worth of all participants regardless of age, gender, ability,
race, cultural background, religious beliefs and sexual identity.
• All persons must accept each other’s views, opinions and decisions without contempt.
• Bullying of any sort will not be tolerated.
• The use of obscene or foul language is forbidden
• Any welfare issues will be reported immediately to British Cycling.
• All riders must observe these rules and follow all instructions given to them by any commissioners or officials
at any time during the event / session.
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