Please return completed form with a cheque made payable to

Surname: ____________________________

First Name: ____________________________

Home Address: ____________________________

____________________________

____________________________

____________________________

Postcode: ____________________________

Home Telephone No: ____________________________

Work Telephone No: ____________________________

Mobile No: ____________________________

E Mail Address: ____________________________

Emergency

Contact Details: ____________________________

(Name & Telephone No) ____________________________

I enclose a subscription fee of £15.00 for the KWCC membership, beginning January 2006. My annual subscription includes BMC membership and third party liability insurance, annual "Summit Magazine" (3 per club), discounted shopping at Cotswold Camping Shops & YHA Group Membership.

I accept that Climbing and Mountaineering are activities with a danger of personal injury or death. I am aware of and shall accept these risks and wish to participate in these activities voluntarily and shall be responsible for my own actions and involvement.

Signed: _____________________________________