Worcester St Johns
Cycling Club
Membership Form
Ver. 2016
Please email or post your completed membership form to Dave Walker (Membership Secretary).
Membership can be paid for via electronic transfer or by cheque.
Payments can be made via electronic transfer to the following account:Sort Code: 30 99 90
Account Number: 02044396
Reference: "Subs 16" should be entered.
Please make cheques payable to "Worcester St Johns CC" and post to:David Walker
19 Lea Close, Claines, Worcester, WR3 7PR
Email: davidwalker69@btinternet.com Mobile: 07799 592520
Membership Type
Senior Members
Family Members
Junior Members
Second Claim Members
Fee
Number
£15
£18
£5
£8
Club Time Trials Season Ticket (optional)
£30 one-off payment for the season to enable you to enter all club Yes
time trials and allows you to have access to the pre-entry system.
Membership Details
Rejoining Member (please indicate)
Last Name
First Name
Male/Female (please indicate)
Date of Birth (DD/MM/YYYY)
Address 1
Address 2
Town
County
Postcode
Telephone Number (including dialling code)
Mobile Phone Number
Email Address
Yes
No
Male
Female
By supplying an email address you agree that club information will be sent electronically
either via email or social media. If you would like to opt-out of this please indicate by
ticking or circling the "Opt Out" text in this section.
Additonal Names (Family Membership Only)
Last Name
Cost
First Name
No
Opt Out
Male/Female Date of Birth
Your details will not be passed to any source for any reason without your express permission.
For more information please contact the club via the Contact page on our website www.wsjcc.co.uk