Club Affiliation Form

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Affiliation Form for Litherland Circuit Races

 for 2012

 

 

NAME OF CLUB ____________________________________________________________

 

SECRETARY       ____________________________________________________________

 

Address :            ____________________________________________________________

 

                           ____________________________________________________________

 

____________________________________________________________

 

 

Post Code :___________________________

 

Contact telephone number(s) :__________________________________________________________

 

Email address : ______________________________________________________________________

 

Club representative to the League if different from above :

 

 

SECRETARY/CLUB CONTACT______________________________________________________

 

Address :            ____________________________________________________________

 

                           ____________________________________________________________

 

____________________________________________________________

 

 

Post Code :___________________________

 

Contact telephone number(s) :__________________________________________________________

 

Email address : ______________________________________________________________________

 

 

Signed by : ____________________________________________________

 

 

Position in Club : _______________________________________________

 

Date : ________________________________________

 

Please complete this form and together with a cheque for £50.00 made payable to: Litherland Circuit League and forward to the LCL Treasurer: Paul Paterson, 50, Ennismore Road, Liverpool, L13 2AT

 

A list of events, results, League positions and news items will be shown on the Merseyside Cycling Development Group website:

 

http://www.merseysidecyclingdevelopment.org/                 and then follow the link on the Home Page

 

Individual Affiliation Form

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Individual Affiliation form for 2012

To the Litherland Circuit League

Sponsored by : www.highonbikes.com

High on Bikes Ltd., 11, Hurlston Court, Scarisbrick Business Park, Smithy Lane, Scarisbrick, Lancashire, L40 8HN Telephone: 01704 841529

Name

 

 

 Address



 

Next of Kin Contact Telephone No.

 

British Cycling Licence No. & Category

 

Name of Club a member of

 

Email Address

 

Date of birth if under 18 years of age

 

     

 

Winners of events may be asked by the Sponsors to do an interview at the end of their race and also, they may take Photos/Video footage of the events.  If, you have any objections to this please indicate by putting a cross in the box  o

 

 

 

 

Payment

For ALL D and E Youth Categories

Free

£2

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

Nil

 

Membership when a Rider's Club/Racing Team has affiliated to the Litherland Circuit League

Youth (A/B & C Categories)

£3

£3

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

Juniors (Male and Female)

£5

£7

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

Seniors - Male

£10

£10

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

Women

£5

£7

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

 

Private Membership - For Riders whose Club/Racing Team have not affiliated to the Litherland Circuit League

Youth (A/B & C Categories)

£5

£5

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

Juniors (Male & Female)

£10

£7

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

Seniors (Male & Female)

£15

£10

Registration Fee for the year 2012

Entry Fee per night of racing in 2012

 

 

None Racing Membership

 

£10

 

Registration Fee for the year 2012

 


Copies of the League Rules and the League Points for each licence category available from the League Secretary, Andy Gibson


Signed By : ____________________________________   Date : ______________________


PARENT/GUARDIAN: I hold legal responsibility for  ……………………………………….and is aged under 18 on the present application. I understand and agree that my son/daughter participates in events promoted under the BCF and the Litherland Circuit League rules entirely at his/her own risk. I have considered and understand the nature of such events and have discussed them with my son/daughter.  I am satisfied that my son/daughter is sufficiently responsible and competent to assume responsibility for his/her own safety.  I understand that my son/daughter participate in such events without any liability whatever on the part of the organisers  or their promoting clubs, the Litherland Circuit League or their officials or members in respect of any injury, loss or damage suffered by him/her.  I confirm that my son/daughter does not have any disability or medical condition physical or mental, which could affect his/her ability to ride safely as a racing cyclist.

 If you do not want photos/video footage being taken of your child please indicate by putting a cross here o

 Winners of events may be asked by sponsors to do an interview at the end of their race with a parent being present.  If you have any objections to this happening please indicate by putting a cross in the box. o

Print Name : __________________________

Signed By : ____________________________________   Date : ______________________

List of events, results, League positions and news items will be shown on the Merseyside Cycling Development Group website:www.merseysidecyclingdevelopment.org/   

The completed Form and affiliation fee (cheques should be made payable to Litherland Circuit League) and sent to Paul Paterson, 50, Ennismore Road, Liverpool, L13 2AT