• This membership gives you Third Party Public Liability Insurance and enables you to

enter The Welsh Nationals, any other surf contest organised by the WSF and also covers you for free surfing anywhere in the world except USA and Canada

• T-Shirt comes with membership. • You will also get Langland Board Riders club member benefits. • Membership runs from 1st March 2015 to 29th February 2016

Please complete the below: Surname: DOB: / / Forenames: Age on 1st Jan 15:

Address:

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Post Code: Home Tel:

Mobile Tel: Email:

T-Shirt Size: Paid: yes / no

T-Shirt Colour: white / black Had T-Shirt: yes / no

~ LBR CLUB MEMBER ~ Signature: …………………………………… Date: …………….. **Parent/Guardian to sign for under 18‘s

Name of P/G: ………………………………….. Relationship to member: ……………………….

Cheques to made payable to Langland Board Riders Post cheque/cash and form to: Langland Board Riders, 28a Northway, Bishopston, Swansea, SA3 3JN

Information supplied on this form will be kept on computer for purposes as registered under the Data Protection Act.

LBR MEMBERSHIP 2015 £20