Hants & Dorset Youth Motocross Club

                                                       Affiliated to Youth Motorcycle Sporting Association Ltd

                                                                  Application form for Club Membership 2007

Family Name (surname)………………………………………………………………………………………………

Address………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………..

…………………………………………………………Post code……………………………………………………

Telephone Number:   HOME  ………………………………   MOBILE …………………………………………

Email                           …………………………………………………………………………………………….

	1^ST Family Member	2^nd Family Member	3^rd Family Member
First Name
Date of Birth
Riding Group
Make of Bike & cc
Engine Number *
Frame Number  *
Preferred Riding No

* These are required to be filled in to help combat bike theft.

Declaration:

I authorise the applicant/s to compete in motorcycle events organised under the regulations of the YMSA (Youth Motorcycle Sporting Association Ltd).  In consideration of their being allowed to compete in these events, I undertake to use my best endeavours to ensure that they observe the appropriate safety regulations, and that they will observe the rules of the YMSA Ltd and HDYMC (Hants & Dorset Youth Motocross Club).  I know of no reason why the applicant should not be issued with a competition licence to partake in motorcycle sport, and I further more authorise any hospital or medical practitioner to furnish any information relevant to the medical condition of the applicant to a representative of HDYMC.

I consent to the above details being held on a confidential database for the purpose of HDYMC information and for invitations to club events etc.  HDYMC are committed to protecting your privacy and adhering to the principles of the Data Protection Act.

I agree to stand by any committee decision to upgrade Novice riders to the Expert group as required

FEES

Individual membership fee                   £ 27

Each additional family schoolboy/girl rider             £ 15

YMSA Licence Fee    £ 30

Please make cheques payable to HDYMC (card details on back of cheque) and enclose Two stamped self-addressed envelopes

Please enclose with your membership form a copy of your birth certificate (new members only)  and two passport size photographs. No licences will be issued without ALL the CORRECT documentation.

Signature of Adult Rider                                

……………………………………………………………………………………………(Or Parent/Guardian of schoolboy/girl rider)

Date    ………………………………………

Return to:                     HDYMC                                              Your new Membership Secretary is Louise Pile

                                    Membership Secretary

PO BOX 6761

WIMBORNE

BH21 9DY                                                Telephone:  07870 676550     ( No calls after 9.00pm)

Please note that only the first 40 riders in each group that book in will be guaranteed a ride. We do closely monitor membership and race entry levels to try to ensure that those who wish to ride can do so.