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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