NSCR Membership Form

Instructor Membership

*Name:

Address:

Tel: Mobile:

Fax: E-mail:

*Work Place Club - Name:

Address:

Tel:

Studio co-ordinator:

No. of classes per week:

Level of classes (if applicable):

Studio Cycling Course & Date You Attended:

*Only these details will be placed on the website www.internet-spinoffs.com

Background details for our records only

Other Clubs where you teach:

Other Qualifications:

Are you interested in attending an upgrade/refresher course? (see list enclosed) Yes/No

Or another Phase of Studio Cycling training: Yes / No

Please state Phase number 1 > 3:

Address for future correspondence to be sent:

I enclose a cheque for £20.00 made payable to: NSCR

Signature: Date:

Please let us know if any of these details change.