First Name *

Last Name *

Membership type *
Please selectSparks (under 14 years)Junior Member (14-18 years)Student (under 23 years)Senior Member (over 23 years)Over SeasNo Helping OutSecond Claim Club

Gender *
Male   Female

Address Line 1 *

Address Line 2

City *

Post code *

Mobile Number *

British Cycling Licence #

Country *
United KingdomAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua/BarbudaArgentinaArmeniaArubaAustriaAustraliaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia/HerzegovinaBotswanaBouvet IslandBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCanadaCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands(Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island/Mcdonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSt. BarthélemySt. HelenaSt. Kitts/NevisSt. LuciaSt. MartinSt. Pierre/MiquelonSt. Vincent/The GrenadinesSamoaSan MarinoSao Tome/PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSpainSri LankaSudanSurinameSvalbard/Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks/Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor IslandsUnited StatesUruguayUzbekistanVanuatuVatican City StateVenezuelaViet Nam"Virgin Islands, British""Virgin Islands, U.S."Wallis/FutunaWestern SaharaYemenZambiaZimbabwe

British Cycling Category
Not applicableElite1st Cat2nd Cat3rd Cat4th Cat

Emergency contact name *

Emergency contact number *

I agree with the clubs code of conduct. Click here to read. * I agree with the clubs code of conduct. Click here to read.

I consent to my data being handled in accordance with the club's privacy policy. Click here to read. * I consent to my data being handled in accordance with the club's privacy policy. Click here to read.