MERTHYR CYCLING CLUB
www.merthyrcyclingclub.co.uk
MEMBERSHIP APPLICATION/RENEWAL FORM – 2009/10
Read and sign this form and return it with your annual applicable subscription to Merthyr Cycling Club:
c/o Adrian Sullivan, Treasurer, 24 The Walk, Merthyr Tydfil CF47 8RS
Or Taff Vale Cycles, Georgetown, Merthyr Tydfil.
Please tick as appropriate: Renewal New Membership
Full Membership £25 Junior (<18free) Non TT/Racing member £15
Second Claim member State name 1st Claim club Hon Life Membership (free)
NB: For Renewals, unless details have changed simply print name, sign and date. __________________________
Full Name: ___________________________________
Address: _______________________________________________________________________
Postcode: _________________ Telephone No. ________________ D.O.B _______________
Email: _____________________________ Emergency Tel. No. ______________________
Merthyr Cycling Club is a non-profit organisation that aims to promote cycling in all its forms as a sporting and leisure activity; included in its activities are recreational and training club rides, time trials, long distance riding, off-road riding, touring and social events.
The Merthyr Cycling Club is affiliated to a variety of National Bodies including the BCF through Welsh Cycling Union, the Welsh Cycling Association, the CTT (RTTC), and the WWCL.
1. I acknowledge, agree and represent that I understand the nature of Cycling Activities and that I am suitably experienced, in good health and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public and upon which the hazards of travelling are to be expected.
2. I fully understand that Cycling activities involve risks and dangers of serious bodily injury. I fully accept and assume all such risks and responsibility for losses, costs and damages that I may incur as a result of my participation (or that of the Junior) in club run activities. I therefore agree that under no circumstances shall The Merthyr Cycling Club, its Administrators and Organisers be liable for any such losses, costs or damages.
Note: It is strongly recommended that members of Merthyr CC also take out either membership of the CTC or BCF insurance, for cover against Third Party insurance claims, legal advice and specialist support should the need arise. It is also strongly recommended that a protective helmet be worn when taking part in Club-run events. For under-16s, the wearing of helmets is mandatory for all CTT authenticated events.
For initial categorisation: Please provide your fastest time-trial time during the last 3 years (if applicable)
10 miles 25 miles
Signature: _______________________________________ Date: ______________________
For Juniors only: Print Name of Parent/Guardian __________________________________________
Signature of Parent/Guardian ___________________________________________
• Free membership for Juniors will be granted only if a parent/guardian is also a member of Merthyr CC (or in the absence of a parent/guardian, an adult member who has agreed to be responsible for the Junior at club activities)
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