Shotley Peninsula Cycling Campaign

Membership Form

Application type (select) New membership    Renewal      Membership No (if known)
Membership type (select)

Individual, £5.50  Family, £5.50  Organisation, £5.50 

Individual 5 year, £21  Family 5 year, £21  Organisation 5 year, £21 

Family membership includes all members of one family at a single address.
Membership fees are for 12 months or 5 years from date of joining.

On-line membership is £5.50 or £21 to cover administration costs,please complete the form and then use the "Buy it now" button on the website.

   
Title    First name    Surname 

Fields in bold are mandatory

Spouse/Partner    Title    First name    Surname 
Children

Please separate names with a comma
Address
 
 
Town
County
Postcode
Telephone
E-mail
   
Membership fee £
Donation £
Total amount to pay £

Please tick below if you are able to assist or have any specific interest:
Leisure Cycling
Safer Journey to School
Assistance with events
Please let us know if you have any special skills or experience that might assist the Campaign.
I/we cycle for: Commuting    Trips about town    Leisure    Sport

 

Then please return to the website to use the "Buy Now" button.

 

or Print the completed form and send with your cheque for £5 or £20 to:
Sally Williams,Treasurer,SPCC,Broadacres,Shotley Road,Chelmondiston,Ipswich, IP9 1EE.
 Cheques payable to Shotley Peninsula Cycling Campaign

Data Protection Act: The information provided above will be stored electronically by Shotley Peninsula Cycling Campaign.
It will be used solely for Campaign administration and not disclosed to any third party.