NCORTC 2025 Membership Application

NCORTC 2025 Membership Application

Before you take part in an event you need to become a member: To compete in an event you need to become a Competitive Member and then pay the event fee of £35. You can do this when signing on for the event. Co-Drivers need to become a Non-Competitive Member and there is no event fee to pay.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Please select as appropriate and contact treasurer to find changes in price per event.*

Competitive Driver Member - September fee of £10Used points for Competitive Driver MemberNon Competitive Member - September Fee £10Used points for Non Competitive MemberLifetime Member
Drivers fill in the details here (If RTV pleace tick RTV box)*

Class1 (50" but not exceeding 87")Class 2 (over 87")Class 3 (Modified)RTV (Road Taxed Vehicle)NoviceNon competitive member
I the above named apply for membership of the Northern Counties Off Road Triallers Club. Membership being subject to approval by the Committee. I agree to abide by the rules (copy available on request) and understand that participation in club events is at my own risk.
Please select NO here if you do not want your contacts details using for club communications*

YesNO
Date*

MonthDayYear
Date
Signature*

Clear
I am aware that NCORTC have developed a Child Protection Policy. Members under 18 years must have written consent from a Parent/Guardian (see the next section below) and be signed on by them at every trial entered.
This document must be read and this section counter signed by the Parent/Guardian of the above named applicant if they are under 18 years of age.

I as Parent/Guardian of the above named applicant am aware that NCORTC have developed a Child Protection Policy, a copy of which is attached to the club rules. A Child Protection Officer vetted by the MSA is available and contact details are published by the Club. I also understand that the Club will attempt to keep records of all persons using video and photographic equipment at events. I am aware that it may be possible that images with my child in the picture may be published. I will advise the Official at signing on, in writing, of details of any known allergies, conditions, medication being taken by my child. I also give consent to medical treatment to be administered to my child where considered necessary. In the event that my child should require emergency hospital treatment, and I cannot be contacted, I authorise a qualified medical practitioner to provide emergency treatment and medication.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Date

MonthDayYear
Date
The clubs bank details are as follows:

Account Name – NCORTC

Sort Code – 05-06-81

Account Number - 33578674

Please send payment through after you have filed in this form. Payment and forms will be matched up by the membership secretary and your membership details will be sent out to you.
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