Northern Vets Cycling Club

Membership Application for 2010

This licence allows members to participate in all races conducted by the Northern Vets Cycling Club inc. (NVCC) and other Australian Veteran Cycling Council (AVCC) affiliated Veterans Cycling clubs throughout Australia.

This licence will be due for renewal on January 1st 2011

Full Membership - $80

Official's Membership (Marshalling duties) - Paid for by the Club

* All details are required!

• Name First Last
• Date of Birth DD / MM / YYYY
• Address Street Address Address Line 2 City Postal Code
• Contact Number # # # # - # # # - # # #

  Mobile or landline
  (e.g. 0363 555 555)

• Email
• Payment Cash Cheque

  Payment can be made
  at the races.

• I AGREE TO ABIDE BY THE RULES & REGULATIONS OF THE N.V.C.C. & A.V.C.C.