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CRMCC
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CRMCC – Trial Membership Form
Personal Details
First Name
(required)
Last Name
(required)
DOB
(required)
Email
(required)
Phone
(required)
Address
(required)
Suburb
(required)
State
(required)
Postcode
(required)
Emergency Contact Details
Emergency Name
(required)
Phone
(required)
Trial Ride Details
No. of previous rides
(required)
0
1
Date of Trial Ride
(required)
Preferred Grade
A Grade
B Grade
C Grade
D Grade
E Grade
F Grade
G Grade
Not sure
Trial ride will be with CAPITAL REGION MASTERS CYCLING CLUB
(required)
Conditions
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)
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