CSH HOUSEHOLD MEMBERSHIP FORM

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All house members must reside at the same address.

ADULT 1

Full name & title.

Name by which you prefer to be known

If a previous member, please advise of membership number if known

Family address (including postcode) *

Mobile phone number *

Email address.

(Correspondence will be via email).

Type of riding preference *

Road

MTB

Both

Would you like to receive our Club e-newsletter emailed approx 4 times a year? *

Yes

Photographs of our rides & riders may be published in our e-newsletter or/and shown on our website. Please indicate if you are willing to be photographed. *

Yes

By submitting this form I acknowledge & accept participation in any Cycle Seahaven ride/event is at own risk, and neither Cycle Seahaven nor the event organisers shall be liable for loss or damage. I also accept responsibility for ensuring appropriate fitness, to have familiarised myself & comply with club rules, and that cycle helmets are compulsory.

I agree

Required

Is there an ADULT 2? *

Yes - Section 2 for Adult 2

No - Go straight to Section 5 for Youth Details

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