EAMG MEMBERSHIP FORM

Essex Advanced Motorcyclists Group Ltd

Promoting Motorcycling Excellence. Registered Charity Number 1107703
MEMBERSHIP/RENEWAL APPLICATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Contact Number
Email Address*
example@example.com
MEMBERSHIP CATEGORY REQUIRED: (please tick relevant box and provide details of test pass where applicable)
Have you passed an IAM or ROSPA test?*

YesNo
IAM/ROSPA Test Pass Date. If unknown you can update us later.

MonthDayYear
Date
Pass Grade
When are you generally available for training?

WeekdaysWeekendEither
MEMBERSHIP CATEGORY REQUIRED (see notes below): Please tick relevant box.*

FULL (IAM/ROSPA) £30FULL+FTFM £50 (£30 annual membership + £20 for further training).ASSOCIATE (renewal) £45SOCIAL £30NEW ASSOCIATE £60.
Note on EAMG categories:

If you already hold an IAM or RoSPA qualification you should apply for FULL or FULL+FTFM membership.

If you do not yet have an IAM or RoSPA qualification you should apply as a NEW ASSOCIATE for your first year and ASSOCIATE (renewal) for subsequent years. If you acheive an IAM or RoSPA test pass, your next renewal will be as a FULL or FULL+FTFM member.
After you have submitted this form, you will recieve an automatic response by email with details of how payment can be made. If you don't see this email please check your Spam folder.

DECLARATION: I declare I have a full and valid driving licence and relevant insurance. My motorcycle will be roadworthy and have valid MoT (if required My cyesight meets legal requirements. Ifl have any personal or medical issues that might affect my riding I will inform my Observer prior to any observed ride. I understand that I will wear appropriate clothing. I will be deemed to be in control of my motorcycle and my actions at all times. I agree that EAMG will accept no liability for any injury, damage or loss whatsoever, however caused.

DATA PROTECTION: I agree to EAMG Ltd holding my personal details on a computer or other format for administration purposes. I do not object to another EAMG member being given my contact details on request.
SIGNED*

Clear
Date

MonthDayYear
Date
Gift Aid Declaration - for past, present & future donations to Essex Advanced Motorcycle Group Ltd (EAMG) Please treat as Gift Aid donations all qualifying gifts of money made by me to EAMG from 1st January 2012 onwards

I understand that the Charity will reclaim 25p of tax on every £1 that I give and I confirm that have paid, or will pay. Income Tax and/or Capital Gains Tax for each tax year ending 5th April that is at least equivalent to the tax reclaimedby the Charity.
Date

MonthDayYear
Date
Signature*

Clear
Please notify EAMG if you wish to cancel this declaration amend your details, or no longer pay sufficient income tax to cover 25% of the donations made. If you pay income tax at higher rates you may claim additional tax relief by including all Gift Aid donations in your income tax return or asking HMRC to adjust your tax code.
Lastly, could we ask a favour? It would be a great help if you could tell us briefly how you heard about EAMG.
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Essex Advanced Motorcyclists Group Ltd