Membership Application Form

January 1st to December 31st
Membership £15 per person or £35 per family (3 or more)

Name.........................................................................................    Date of Birth.............................................................

Address.............................................................................................................................................................................

.............................................................................................................................................................................................

Telephone.....................................................    Email Address.....................................................................................

School/College/Occupation..........................................................................................................................................

Additional Members if from the same family

Name.............................................................................................    Date of Birth..........................................................

Name.............................................................................................    Date of Birth..........................................................

Name.............................................................................................    Date of Birth..........................................................

Parental or Guardian consent, to be completed for members under 18years.

I,...................................................................give my consent for my son/daughter to take part in BMX activities at Tiverton BMX Club.

Signature......................................................................................     Tel No....................................................................

Emergency contact name and number.....................................................................................................................

Please list any known allergies or medical conditions.........................................................................................

..............................................................................................................................................................................................

I would like to become a member and have listed the names and dates of birth of any additional members above. I have enclosed the membership fee and agree to abide by the club rules.
BMX racing is a contact sport and all riders ride the track at their own risk. I agree that we will not hold Tiverton BMX Club or its officers or members liable for any loss or damage of our Childs property or injuries to him/her however caused. I further agree that should my child require hospital treatment in consequence of any injury sustained during the course of BMX activities to which this application refers any consent normally required by me for treatment of such child can in my absence be given by any member of the Tiverton BMX Club committee. The Tiverton BMX Club will endeavour to contact the Parents or Guardians ASAP should such an accident occur.
The Tiverton BMX Club is run by volunteers and relies on the goodwill of others to continue the clubs development. If you would like to offer advice or practical help to the club to further its aims please contact us.
Please return forms with Cheque (Cheques made payable to Tiverton BMX Club) to Tiverton BMX Club c/o 45 Siddalls Gardens, Tiverton, Devon, EX16 6DW