Membership Application
Application Form
To request membership please complete the boxes below:
Applicant:
First Name:
Surname:
Applicant:
First Name:
Surname:
House Name / N
o
& Rd / St:
Town:
County:
Post Code:
Country:
email address:
Telephone Number:
Telephone Alternative:
Do you have any objections to your name and telephone number being listed in the membership directory? (Addresses are not published)
Yes
No
Could you help a member in distress whilst in your area?
Yes
No
1st
2nd
Registration N
o
of your CBX motorcycle:
Colour:
Model:
What are your main interests?
Rallies
Touring UK
Touring Abroad
Nothing Special
Other
Would you be able to show your bike in a local event?
Yes
No
Do you have any skill or contact which could help the club and its members?
If so please list....
How did you learn about us?
The membership year runs from 1st April to 31st March.
The annual fees are:
Single membership £25.00 per annum (£2.50 per month if joining mid year) + £2.00 administration fee for new members.
Overseas members including Rep of Ireland £29.00 per annum (£2.50 per month if joining mid year) for non UK members + £2.00 administration fee.
£6.00 per annum (50p per month if joining mid year) for additional family members
(must be family not friends)
.
Payments can now also be made via paypal or standing order.
If you need advice with regard to subs please contact the club
on this link
or call Mel Watkins on 01 745 827026 between 10 a.m. & 8 pm. anyday including weekends. If joining between 1st January and 1st March contact the above number as discounts may apply.
If you wish to pay by debit or credit card please advise full card number, expiry date, issue number if on front of card, last three digits of security number on back of card and name of cardholder. Please also confirm the registered address of the cardholder. Please contact the above number for further information if necessary. A £2.00 fee to help towards bank fees will be added to any card transaction.
I understand that the CBX Riders Club cannot assume any responsibility for any aspect of my safety or property while participating in any club events. I accept that my personal information will be held on computer for administration purposes only and will not be passed on to any third party.
I agree
Disagree
Please make your cheque payable to
CBX Riders Club
and send to the club chairman:
Mel Watkins
9, Trem y Mynydd,
Belgrano,
Abergele,
Conwy,
LL22 9YY
Click here to submit:
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