Club Membership Registration Form

Beaudesert Cycling Club Membership Registration

Complete the form below to sign up for our membership service.
Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:

DayMonthYear
Where did you hear about us?

A Friend or colleaugeGoogleBlog PostNews Article
Other Memberships
Are you a member of

Cycling Australia/QueenslandBicycle QueenslandMtBAOther
Membership #
Membership Expiry Date
Emergency Contacts
Name

First NameLast Name
Phone Number

Area CodePhone Number
Payment for Membership/Renewal

Cash/Cheque - Please complete form and payment

In Person to Scott Launder - Treasurer or

Via Post to PO Box 641 Beaudesert QLD 4285

Bank Transfer - Bank Account Details

BSB 084 536

Account No: 14 880 6844

(Please provide name in reference)
Conditions of Membership

It is acknowledged that BCC Inc. (Beaudesert Cycling Club Incorporated) DOES NOT COVER INDIVIDUAL MEMBERS ACCIDENT & LIABILITY INSURANCE. This is your responsibility and is available free with either Cycling Australia or Bicycle Queensland membership which is strongly recommended.

As a member you give permission for BCC Inc. to use an images taken for advertising and/or promotional purposes (please see any committee members with any relevant queries).
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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Beaudesert Cycling Club Membership Registration