Leigh Premier Road Club

Founded 1964

 
Membership Application Form 200.

 

 

 

Full Name

 

Address ...

 

 

 

Post Code . Phone No ..

 

Email .

 

Category Annual Subs Tick appropriate box

 

Senior

10

 

Junior

10

 

Juvenile

5

 

Social

5

 

2nd Claim

5

 

 

Previous Club (if any) or 1st Claim club .

 

Interests and memberships

 

Please list any other club memberships (ie BCF CTC etc) and what you cycling interests are

(ie road race, time trial, cyclo-cross, MTB, touring,coaching etc)

 

 

 

 

 

 

I wish to apply for membership of Leigh Premier Road Club and agree to abide by its rules, regulations and by-laws.

 

 

Signed Date .

 

Parental signature if under 18 .

 

Membership application is subject to the approval of the committee.