Christchurch Singletrack Club Membership Form

Please type what you can see (if you can't read it click on the arrows for another choice): Required Question

1. Your details

First Name

Last Name

Street Address

City

Postal Code

Email Address

Phone - home

Phone - work

Mobile Phone

2. Relevant medical conditions (eg asthma, bee allergy, heart condition)

3. Emergency Contact Details

First Name

Last Name

Relationship to you

Phone Number

Mobile Phone

4. Due to my profession/training/experience, I can offer assistance in the following areas:

5. I have the following skills and/or interests that I would like to share with the club as a social or educational activity:

6. Which of the following email lists would you like to be added to:

	Club newsletter
	Canterbury Mountainbikers News
	Helper list for club races
	Trailbuilding on the Port Hills
	Trailbuilding at Living Springs
	Beginner Rides
	Helper list for club social activities

Club Rules

1. Every member must wear an approved hard shell safety helmet that is correctly fitted, and enclosed footwear, while riding at club events

2. Bicycles must be in good working order with functional front and rear brakes, handle bar ends must be plugged and have no sharp edges.

3. Riders must not use abusive or offensive language at events, behave in an anti-sporting manner, be disrespectful to other club members or ignore club rules.

I have read and undertand the club rules

Yes

7. Please enter your name and the date below if you agree with the following statement:
I hereby agree to abide by all club rules of the Christchurch Singletrack Club Inc. I attest that I am sufficiently fit to ride in general and at events safely and am aware of the risks involved. I hereby exempt the Club, Event Organisers, Landowners and Sponsors from any liability for damage that may occur to me or my property. Required Question

Name
Date

8. The 2009/2010 Membership fee is $10 per family. Please indicate which of the following applies: Required Question

	I am paying the annual family membership of $10
	My family membership fee has been paid by someone else

Name of family member who has paid your membership fee

9. Donations are gladly accepted. If you wish to make a donation, please indicate the amount here:

10. Please advise how you intend to pay your membership fee and/or donation Required Question

	Not applicable
	Cheque - make payable to Christchurch Singletrack Club
	Bank deposit - 02-0820-0128675-083 at BNZ
	Cash at a club event or meeting

11. Do you require a receipt?