Application

• *

  First	Last

• Date of birth *

  Day	Month	Year

• Email *
• Telephone *
• Mobile
• Address *
• Type of membership * Senior £10 Family £15 Associate Junior £6
• Other family members 1 (under 18, if applying for family membership)

  First	Last

• Date of birth

  Day	Month	Year

• Other family members (under 18) 2

  First	Last

• Date of birth

  Day	Month	Year

A separate Parental consent Form must be completed if the rider is less than 16 years old. A “Senior Rider” must accompany riders under 13 years old. Membership and Insurance renewable on 1st October annually although no renewal will be due if membership is granted within three months of the renewal date
• Third Party Insurance (Non CTC & BCF Members)

  I require further information about third party insurance

Payment Options

• Pay by PayPal or Debit/Credit Card (Renewal date is 1st October)
• Post a cheque made payable to ‘Wellington Wheelers’ to Dave Barker, Sandene Close, Rectory Road, Staplegrove, Taunton, TA2 6EL

Membership Type

Senior Adult £10.00 GBP Family (2 adult + under 18)s £15.00 GBP