Membership plus Additional Child

Before filling out your details, we strongly recommend you read our club rules HERE and the Cycling Ireland code of conduct HERE.

Members Details

Name*

Date of Birth*

Phone Number*

Email*

Gender*

MaleFemale

2nd Members Name*

2nd Riders Date of Birth*

Address*




Emergency Contact

Please indicate below the person who should be contacted in an emergency*

Relationship to Member(s)*

Phone Number*

Email*

Medical Information

Please detail any underlying, recurring or present ailment or medical condition, however minor it may appear. Typical examples would include but are not limited to: epilepsy, asthma, diabetes, heart or respiratory conditions, recent injuries, allergies, etc.

Medical condition(s) and recommended treatment/actions to be taken if symptoms appear: If you have any concerns about participating in any form of physical activity then please consult your GP before taking part in cycling activities or sessions.

Membership Fees

Terms and Conditions*

by clicking this box you agree to abide by all the Terms and Conditions associated with becoming a Club Member, Our Rules and Cycling Ireland's Code Of Conduct (if under 18 years this must be clicked by a parent or guardian)

I confirm that photographs of me (or my child/family) can be used for promotional purposes
I agree that I'm a member of Lisburn BMX club, and if not I agree to initiate club transfer.

After you hit Pay Now, you will then be directed to PayPal to pay your fees within 5 seconds. Please don't hit more than once.