Registration Form

Personal Details = required

Full Name

Email Address

Alternate Email

Date of Birth

Membership Start

When would you like your membership to start?

As Soon As Possible Specific Date

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost
	Corporate Supporter - Large Business Businesses with less than 250 full time/full time equivalent employees	£250.00
	Corporate Supporter - Local Cycling Business Local (<25 mile radius of York) businesses that are directly linked to cycling i.e cycle shops, cycle couriers.	£50.00
	Corporate Supporter - Medium Business Businesses with less than 250 full time/full time equivalent employees	£150.00
	Corporate Supporter - Micro-business Businesses with less than 10 full time/full time equivalent employees	£50.00
	Corporate Supporter - Not-for-profit Organisations Businesses, and other organisations, operating on a not-for-profit basis	£50.00
	Corporate Supporter - One Person Business For businesses with a single employee	£25.00
	Corporate Supporter - Small Business Businesses with less than 50 full time/full time equivalent employees	£75.00
	Individual Only available to people aged 18 or over.	£5.00
	Reduced For those who feel they can't afford our full price individual, our Reduced membership offers all the perks of the regular Individual membership Only available to people aged 18 or over.	£2.50
	Household Up to 5 individuals in the same household	£10.00

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://www.myclubhouse.co.uk/YorkCycleCampaign/Home/TermsAndConditions) and the Privacy Policy (https://www.myclubhouse.co.uk/YorkCycleCampaign/PrivacyPolicy;).

Signature

Date

Please return completed forms to:

Use this form to send an email to another member. You may only send to one member at a time. Your registered email address will be passed on to this member but you may also include alternative contact details.

Note: Emails sent via the website are not entirely private. A copy of every email is held on the database and this can be accessed by the Campaign committee members using the Sent Emails page.

From

Alternative contact email

Another email address which the recipient can use to contact you.

Alternative contact details

Other contact details which the recipient can use to contact you e.g. phone number.

Subject

Message

Copy this message to my email address

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Description

Requested Membership Subscriptions

One or more of the requested Membership applications require approval. You will be emailed if your request has been approved and, at that point, you will be able to view and accept or reject the membership offer and proceed with payment. will be emailed once the request has been approved and, at that point, they will be able to view and accept or reject the membership offer and proceed with payment.

Subscriptions have been automatically approved and have been added to your basket. Please now proceed there to make payment.

Pay for Subscriptions

Reference	Name	Category	Costs
			Joining Fee Cost /	View Manage

Group Subscriptions

- :

You have requested one or more group membership subscriptions. You should now use the register buttons below to add additional members into the available slots.

No.	Membership
	One of:

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