Bulwell Outlaws BMX Club
		Membership Form
		2007
Surname			Forename
			Home Tel Number
Address
			Mobile Tel Number
			Date of Birth
Postcode			School Year
Medical Conditions
			School
			I enclose my Membership Fee of
G P			£ 10....................................................
			(cheque made payable to Bulwell Outlaws)
			Signature		(Parent if under 16)
DATA PROTECTION ACT 1988
Bulwell Vision may use this data and take photographs in order to publicise activity for partners and
agencies associated with funding streams. Bulwell Vision may contact you with information regarding
their programme/ activities/workshop. Your co-operation is entirely voluntary and any information
given will be treated in the strictest confidence. Please tick to confirm you have read and agree to
this statement	[ ]
Please return to			Emergency Contact Number
Karen Law		0115 9162282	Name
4 Ockerby Street		07970 920439	Address
Bulwell		the.laws@ntlworld.com
Nottingham			Contact No
NG6 9GA
			Name
			Address
			Contact No
www.bulwelloutlaws.co.uk