Membership | Rockingham F W

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Name

DOB

Phone

Home address

Emergency Contact Name

Emergency Contact Number

Relationship to person applying

Emergency Contact address

Membership claim type

RFW as First Claim (your main club/team)

RFW as Second Claim (a secondary club for you)

Name of first claim club

This application is for me as

an individual

part of a couple/family

an individual juvenile/junior

Membership Costs are

£15 for Adult - First Claim
£7.50 for Adult - Second claim (if already member of another British Cycling club, which you must name in the box above left)
£25 for a Couple/Family
£5 for Juniors (under 18)
Juveniles (under 16) are free

Please pay by sending the correct amount to our bank account, describing the transaction using 'NEW yourname'.
Our account details are

Thank you! We will be in touch.