Paper Membership Form
Membership Form for Non On-Line Membership Form and Subscription to be sent to: 3cTri membership secretary…whoever that may be Personal Details Title Forename Surname Gender DoB (dd/mm/yy) Occupation Address Home No. Mobile No. Email Address (Please write Clearly) Emergency Details Name Phone Please note any Medical Information we should be aware of eg. diabetic, epilepsy, etc. Club Details Yes/No Are you a member of another club? Do you agree to obey the rules of the Club and England Tri Yes / No Cost 1 year Membership Yes / No Yes / No Total Plastic Member Card Cheques should be made payable to 3cTri £22 £3 Declaration Signed Date In signing this form I agree that I run at my own risk in accordance with the club’s safety requirements. I also agree that my name and other club-related details can be stored on a computer database. (This information is solely for the use of the club and will not be passed on to anyone else) Standing Order Authority To (Bank Name) Account Name Bank Address - (if you already have a SO then pl. indicate it already Account No. exists with [name of bank]) Sort Code Date Signature This standing order supersedes any previous standing order with this reference, payable to 3cTri. Please pay £________ upon receipt of this Standing Order and on the whenever the club year thenceforth until cancelled by me to :To be Completed by Membership Secretary A big Bank Sort Code:_________________Account Number:_____________________ Account Name:______________________________Reference: SJ_______
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