Application Form for Wok and Rice Club Membership

I (full name) _________________________________________

of (address) _________________________________________

___________________________________________________

___________________________________________________

Date of Birth _____________

Apply for full/social/concession membership of the Wok and Rice Club. I acknowledge receipt of a copy of the Club's Constitution (and rules) and agree to be bound by them.

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: ____________________________________

Date: ___________________________

Signature of Parent or Guardian (if member under 18 years)

Signed: ______________________________

Date: _______________________________

Full Name and address of Parent or Guardian:

___________________________________________________

___________________________________________________

___________________________________________________