Affiliation Form for Litherland Circuit Races Sponsored for 2010 by Chia Cycling Promotions

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 Develepment Group website:

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