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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