Membership Application and Renewal Membership Application Type(required)New ApplicationRenewalFirst name(required)Last Name(required)Address(required)Town/Suburb(required)Post Code(required)Mobile Number(required)Email address(required)Emergency Contact Name(required)Emergency Contact Mobile(required)Membership Payment There are 2 options for paying membership, the Club's prefered option is Option 1: 1. Payment directly to the Club via Direct Credit from your bank account. 2. Payment via Auscycling Membership – NOTE if you use this method you must nominate Macedon Ranges Cycling Club as your club when you join Auscycling.Insurance Details 1. All members must hold insurance through either Auscycling or Bicycle Network. If you have equivalent cycling insurance through another organisation please email the details to macedonrangescyclingclub@gmail.com. 2. Auscycling members may pay Club membership fees by nominating the Macedon Ranges Cycling Club at the time of registering with Auscycling. 3. Bicycle Network members must pay the Club membership fees directly to the Club, separately from the Bicycle Network membership fees.Insurance(required)AuscyclingBicycle NetworkOther Cycling InsuranceMembership NumberMembership Category(required)AdultFamilyJuniorAssociateVerify Age(required)I am aged 18 years or over.Number of Additional Family Members(required)1234Additional Family Member 1First Name¹(required)Last Name¹(required)Mobile number¹(required)Email address¹(required)Insurance¹(required)Cycling Victoria/AustraliaBicycle NetworkOther Cycling InsuranceMembership No.¹Additional Family Member 2First Name²(required)Last Name²(required)Mobile Number²(required)Email address²(required)Insurance²(required)Cycling Victoria/AustraliaBicycle NetworkOther Cycling InsuranceMembership No.²Additional Family Member 3First Name³(required)Last Name³(required)Mobile Number³(required)Email address³(required)Insurance³(required)Cycling Victoria/AustraliaBicycle NetworkOther Cycling InsuranceMembership No.³Additional Family Member 4First Name˜(required)Last Name˜(required)Mobile Number˜(required)Email address˜(required)Insurance˜(required)Cycling Victoria/AustraliaBicycle NetworkOther Cycling InsuranceMembership No.“Junior Membership is for Club Members aged 17 years and under. *Membership must be approved by a parent or guardian. *Junior members must be accompanied by an adult on Club rides except for rides specifically for JuniorsDate of Birth(required)Parent/Guardian First Name(required)Parent/Guardian Last Name(required)Parent/Guardian Mobile Number(required)Parent/Guardian Email address(required)Associate members are non riding members If not a member of C.A or Bicycle Victoria, Associate members can type "Associate" into membership number box in the Insurance section. Terms and Conditions of Membership of the Macedon Ranges Cycling Club In participating in any Macedon Ranges Cycling Club (MRCC) rides, training and associated events that are organised by the MRCC or its members, I hereby acknowledge, agree and confirm the following: There are inherent risks associated with cycling related activities that may result in personal injury (even of a serious nature) to participants. I fully accept and agree to bear these risks. To the full extent permitted by law, I absolve, release, discharge and indemnify MRCC, its officers, members, representatives and agents from any and all liability for any personal injury, mental anguish, loss or damage of any kind suffered by me, however caused, arising out of my participation in the activities, including without limitation, where caused by any acts of negligence by the indemnities. I will maintain an ongoing membership of Auscycling or Bicycle Network or other equivalent cycling insurance for insurance purposes. I agree, whenever possible to wear the Club jersey, as it promotes the Club and assists the Club to establish and maintain an identity. I agree to encourage and support Club Members who are less experienced cyclists. I agree to be courteous to members of the Club and the public when riding, obey all road laws and abide by our Club's Code of Safe Cycling Practice. By clicking on the check box below: I/We declare that I/we have read and understood the above and accept full responsibility for my/our safety each time I/we participate and I/we waiver any claim I/we might have on MRCC as set out above.I/We Agree(required) When you click on the Send button below, your form will be emailed to the Club.I will be paying by the following method.(required)Direct Credit from my bank accountAuscycling MembershipSendThis field should be left blank
