Membership Application Form

Application Form

• First Name:*
• Surname:*
• Address:*
• Post Code:*
• Home telephone number including code:*
• Email address:*
• Mobile telephone number:*
• Contact person in an Emergency including relationship:*
• Home Telephone number & code of person:*
• Mobile telephone number of person:*
• Walks length preference :

  • 5 miles
  • 8-10 miles
  • I am in a good state of health for country walking. (Please tick to verify)
• Preferred pick up point for coach:

  • Spring Bank West, Derringham Bank.
  • Hessle Square
  • Red Lion Inn, Anlaby
  • Hop Pole Inn, Kingston Road, Willerby
  • Willerby Square
• Club contact numbers:

  • Club Telephone Numbers: 01482 652147, Mobile 07979296013.
  • Email address: [email protected]
• Submit