membership form

Name *

First Name

Last Name

Phone

(###)

###

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Date of Birth

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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WhatsApp Preferences

Please tick the boxes of the club groups you are interested in:

BSCC News

BSCC Social

Off-Road

Do you give permission for BSCC to use photos and/or videos of you on our social media, website, and other promotional materials *

Yes, I give permission.

No, I do not give permission.

Insurance Details *

Please provide your membership numbers and expiry dates for the following cycling organisations:

British Cycling

Cycling UK

Other

I apply to renew my membership of the Bishop’s Stortford Cycling Club and agree to abide by the rules of the club and contribute to club activities. I am covered by 3rd party insurance by BC / CyclingUK / Other. I have paid by bank transfer (Bishop’s Stortford Cycling Club 09-01-54 / 12948605) / enclose a cheque. bsccsec@outlook.com. *

Declaration