Membership Form
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| Membership Form |
| Name |
| Address |
| Tel No. Home |
Work |
| EMail Address |
| Other contact point for newsletter delivery (e.g. through work, other member etc.)
|
| I would like to help with: |
| Monitoring route maintenance |
|
Responding to local consultations |
|
| Dr Bike clinics |
|
Letter writing |
|
| Cycle training in schools |
|
Stalls at events |
|
| Other: |
|
|
|
| Prices |
1 yr |
3 yrs |
|
Donation |
Total |
| Individual Membership |
£2 |
£4 |
|
£ |
£ |
| Family Membership |
£3 |
£6 |
|
£ |
£ |
Please make cheques payable to Derby Cycling Group and post completed form to:
Derby Cycling Group
5 Regency Close
Littleover
Derby
DE23 1TR
If you wish to receive a membership card, please enclose a stamped addressed envelope with your cheque.
Data Protection: Derby Cycling Group keeps its membership records on a computer, and this information is not disclosed to third parties, but let us know if you object.
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