Prospective Membership Application

Personal Details Title

Full Name

Address

Postcode

Phone

Mobile

email

Birth Date* U18 Form completed? Yes / No

I am a student in full time education Yes / No * Under 18s: Please confirm that the Under 18 policy & in loco parentis forms have been read and signed.

Your Climbing Experience Can you safely and responsibly:

Essential** Tie into a harness Yes / No

Belay and lower a top-roped climber Yes / No

Climb indoors on a top rope Yes / No

Desirable Belay a lead climber Yes / No

Second an outdoor climber Yes / No

Lead outdoor routes placing protection Yes / No

Navigate in the mountain environment in summer conditions

Yes / No

Climb in winter conditions Yes / No

Outline your Climbing Experience: ** Essential skills: if you are not competent in these essential safety skills we strongly recommend that you undertake basic climbing instruction before participating in club activities.

Participation Statement The NMC recognises that climbing, hill walking and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.

Declaration In applying for membership I confirm that I have read and understood the NMC participation statement, and am fully aware of the activities involved and the risks entailed. Signed: Date: (Parent or Guardian to sign if applicant is under-18)

Prospective Membership is currently £15.00 and is valid for 6 months from receipt of payment. Applications are to be sent to the NMC Membership Secretary by email (preferred) or post; payment via direct debit can be authorised here: https://dashboard.gocardless.com/api/paylinks/0872P9H93J

Adrian Wilson, NMC Membership Secretary, 23 Hamsterley Drive, Killingworth Newcastle upon Tyne, NE12 6TB

Tel: 07970 823 483 Email: membership@thenmc.org.uk