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Please send to the Membership Secretary, Loughborough and District Cycle Users' Campaign, 32 Bramcote Road, Loughborough, Leics. LE11 2SA.

If you have any queries, please feel free to phone us on Loughborough 211468.

I/We wish to join the Loughborough and District Cycle Users' Campaign.

Name(s) ________________________________________________

Address ________________________________________________

________________________________________________

________________________________________________

Postcode ____________

Telephone ___________________________

Email ________________________________________________

Place of work ________________________________________________

Annual Subscriptions
Type Low Income Standard
Full Member £1 £2
Household # £2 £4
Commuted membership:
Pay 5 years in advance
for 6 years membership

(Please circle as appropriate)

# several people at the same address.

Please make cheques payable to the Loughborough and District Cycle Users' Campaign.

I do not object to the group keeping these details on a computer database, providing they are not released to any outside bodies.

Signed ________________________________________________

Date ____________

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