East Lancashire Road Club & Rochdale CTC

Membership

Title (Required)

First Name (Required)

Last Name (Required)

Email Address (Required)

Date of Birth (Required)

Home Phone Number

Mobile Phone Number

Address

Address Line 1 (Required)

Address Line 2

Address Line 3

Town (Required)

County

Postcode (Required)

Club Email Distribution List

Do you wish to be included?

The club uses WhatsApp groups to promote events. Would you like to be added to ELRC WhatsApp groups to be kept up to date on ELRC rides and discussions?

Emergency Contact Details

Name (Required)

Relationship (Required)

Contact number (Required)

British Cycling Membership

Membership Number (Required)

Expiry Date (Required)

Cycling UK Membership

Membership Number

Expiry Date

ELRC Membership (Required)

What type of membership are you applying for?

Add a donation to the club (private & discretionary)

Manchester District of Cycling Time Trials