Register for a Ross cycling club membership

Title * select Mr Mrs Miss Ms Master Dr Rev Prof Hon

First name *

Surname *

Date of Birth * DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM January February March April May June July August September October November December / YY 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Please note if under 18 parental consent is required. A separate form will need to be completed and emailed or posted.

Gender * Select Male Female

Email *

Mobile

Membership * select Adult - £20 (If sent by Standing Order: £15) Junior (under 18) - £5

I would like to become a first claim member.

Medical Conditions

I wish to share my medical conditions

Password *

Confirm *

I would like to:

Join the club email mailing list

Receive email alerts from club website

Share my email with the club

Share my telephone with the club

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