Membership Form

Please fill out the following form in order to submit your annual membership to GDW. Please ensure you use your surname and initial as a reference in the Paypal payment.

Name*
Prefix First Last
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth*
DD slash MM slash YYYY
Claim*
Select if GDW will be your first claim club (you main and preferential cycling club) or your second claim (you are a member of another cycling club as a first claim)
- First Claim
- Second Claim
First claim club name*
Membership Type*
(includes £1 charge to cover PayPal fees)
Subscription Type*
- One off payment
- Recurring Payments
Total
£ 0.00
Emergency Contact Name*
Prefix First Last
Emergency Contact Phone*
Other family members
For Family Membership please insert other persons and dates of birth below:
Additional members*
Name D.O.B
Other partner
For Couples Membership please insert the other persons and dates of birth below:
Additional members*
Name D.O.B
Agreement*
- I agree
I apply for membership as a First/Second* Claim member and I agree to abide by the Club Rules and, if I am under 18 years of age, my parents are aware of my application. I consent to the Club holding the details on this form in an electronic database.

Membership Form

Other family members

Other partner

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Name	D.O.B

Name	D.O.B