Ringwood Motocross Club

Member’s Full Name …………………………………………………………..………………….
Address …………………………………………………………………………………………….
…………………………………………………………………Post Code …...…...…………….. Tel: No ……………………….……………... Mobile No …... …….………………………….
Age (If under 18yrs)………………………... Date of Birth ……..……………………………..

Rider Group ……………………… (AUTO, JNR, S/W, B/W, SNR, AMX Open, VMX Open)
Or tick box if joining as a non riding club member □
Preferred Race No. (if available) ……………………...… (numbers 1-99 only please!)
2010 BSMA Licence Required YES / NO
(if NO which BSMA Club are you licensed with and what is your licence number)
Club ………………………………………… Licence Number…………………………………...

I want to help in the following race day roles: (please circle a maximum of three roles):
 
Clerk / Steward / Scrutineer / Gates / Lapscorer / Points / Marshal / Start Pegs / Finish Flag

Membership Fee : £40 / Family £60 (payable to: Ringwood MX Club)

Family membership: Please complete 1 form per member and ask each person to sign the form.

I wish to become a member of the Ringwood Motocross Club for 2011 and agree to abide by the rules of the club and the BSMA. I understand that attendance at these events is done entirely at my own risk. The Organisers and any person having any connection with the promotion of these events including the Landowners are absolved from all liability (whether fatal or otherwise) howsoever caused. The Management Committee of the Ringwood Motocross Club reserve the right to refuse membership to the club for any reason.

Additional rider declaration: I certify that I/my son/my daughter do not suffer from any disability or impairment likely to prejudice my own/his/her safety or the safety of others.

Signature of Member (Adult rider’s) …………………………………………………………… ………
Name of Parent/Legal Guardian (if rider under 18) ………………………………………...................
Signature of Parent/Legal Guardian (if rider under 18) ……………………………………….............
Date ………………………………………
PLEASE RETURN COMPLETED FORMS WITH FULL PAYMENT & SAE BY 1ST JANUARY 2011 TO
RESERVE YOUR CURRENT RACE NO. OR IT MAY BE RE-ASSIGNED TO NEW MEMBERS. THANK YOU

  Ringwood Motocross Club, 126 Verity Crescent, Canford Heath, Poole, Dorset BH17 8TZ