CRMCC – Trial Membership Form - Capital Region Masters Cycling Club

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Personal Details (required)

First

Last

DOB (required)

Email (required)

Phone (required)

Phone

Address

Residential address with Street, Suburb and Postcode

Emergency Contact Name (required)

First

Last

Emergency Contact Phone (required)

Contact Phone

Trial Ride Details

Enter any comments here

Preferred Grade (choose one)

Preferred Grade

Date of Trial Ride (required)

Date of Trial Ride (DD/MMYYYY)

Phone DOB Phone

Conditions

Trial ride will be with CAPITAL REGION MASTERS CYCLING CLUB (required)
I agree to the terms and condition for participating in a trial ride with an AVCC affiliated club (required)
I acknowledge that the AVCC will store the personal details submitted on this form as a record of my participation in a trial ride with an AVCC affiliated club (required)

CRMCC – Trial Membership Form