Irish Veteran Cyclists Association Limited
MEMBERSHIP APPLICATION FORM
2002/2003

I, the undersigned, wish to apply for membership of the Irish Veteran Cyclists Association Ltd.
In the event of the company being wound up and unable to pay its debts, I agree to contribute the sum of Euro 1.27 to the funds of the Company if and when required to do so.
Please tick (Ö ) the membership option(s) required in the corresponding box(es) below:

BASIC MEMBERSHIP FEE

25 EURO

[   ]

PERSONAL ACCIDENT INSURANCE

50 EURO

[   ]

RACING LICENCE

50 EURO

[   ]

ALL OF THE ABOVE

125 EURO

[   ]

ARE YOU ELIGIBLE FOR FREE MEMBERSHIP? (see Note)

[   ]

Note
Members over 66 of age with 10 years consecutive membership of the IVCA are now entitled to free membership and racing fees. If required, they must pay for Personal Accident insurance (which is compulsory in order to race). If you qualify for free membership
and / or racing fees, you must still complete and return this form, ticking the required boxes above.

 PLEASE USE BLOCK CAPITALS 

Surname .......................................................... First Name .................................................

Address..................................................................................................................................

................................................................................................................................................

...............................................................................................................................................

 Phone Nos: Home ......................... Work .....................................Mobile:..............................

E-mail address: ........................................Fax: .........................................................

Signature: ...............................................Date: .....................................................

Amount enclosed:    EURO ....................................................
(Insurance cover commences when membership fee, inclusive of premium, is paid)

Completed forms should be sent, together with appropriate fee, to:-
Paul Deans, 2 Green Lawns, Skerries, Co. Dublin.
Cheques/Postal Orders should be made out to the  Irish Veteran Cyclists Association.
Please do not send cash in the post.

All members taking out a racing licence will be required to assist as marshal at events promoted by the Company. A member failing to honour this requirement will not be permitted to take part in any such events until he/she fulfils his/her duties as a marshal.

 
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