Date of Birth*
Please indicate below the person who should be contacted in an emergency*
Relationship to Member*
Please detail any underlying, recurring or present ailment or medical condition, however minor it may appear. (Examples would include epilepsy, asthma, diabetes, 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.
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 myself / my child 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.
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Please see our contact page above for full club info
Address: Bells Lane, Lambeg, Lisburn, BT27 4QJ
Facebook: Lisburn BMX Club