Enrolment Form
Matlock Cycling Club-Wards ShoeShops-Clarks
Enrolment Form 2004
Subscription Prices
Club Subscription
Juvenile/Youth £1.00
Junior £1.00
Under 23 £5.00
Senior £10.00
Family £15.00 ____ _____
Additional Senior ____ _____
Please circle the subscription included in your payment.
Where payment includes more than one individual in the same subscription category, please indicate the number of individuals beside the relevant price.
Anyone requiring BCF membership should request a BCF form from the Secretary
Names: _________________________________________________ Date of Birth:_____________________
________________________________________________________ Date of Birth:_____________________
________________________________________________________ Date of Birth:_____________________
________________________________________________________ Date of Birth:_____________________
________________________________________________________ Date of Birth:_____________________
Address: _______________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Please name any schools attended.
Please notify any change of address to the Secretary as soon as possible.
Phone No: Home: ________________________ Work: ______________________
Fax: ________________________
E Mail: ________________________
Cycling Interests:
On Road Leisure ___ Off Road Leisure ___ BMX ___ Road Racing ___
Time Trialling ___ Cyclo Cross ___ MTB Racing ___
Touring ___ Track Racing ___
Amount Paid : _______________
Please make cheques payable to Matlock Cycling Club
Return to: Tony Holmes, Secretary, Matlock Cycling Club,
The Old Smithy, Chesterfield Road, Two Dales,
Matlock, Derbyshire, DE4 2EZ
For more details Ring (01629) 734996 or Email cj@argonet.co.uk.
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