Shotley Peninsula Cycling Campaign

Membership Form

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
 
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
 

or Print the completed form and send to:
Sally Williams,Treasurer,SPCC,Broadacres,Shotley Road,Chelmondiston,Ipswich, IP9 1EE.
 

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.