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


Date of Birth*

Phone Number*




2nd Members Name*

2nd Riders Date of Birth*


Emergency Contact

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

Relationship to Member(s)*

Phone Number*


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.