Rowley Regis Disability Centre

Membership Application Form

If you wish to become a member of the club, the easy option is to come along on a Wednesday evening and have a chat.
Alternatively, you can complete the application form and we will contact you and discuss what the club has to offer.
We can also arrange for you to be picked up by Ring and Ride, if you complete the online application form we will contact you before adding you on to the ring and ride list.

Privacy Statement

The Disability Club has a legitimate interest in using personal data you give to us on this form for the purpose of communicating with you on matters relating to Disability Club.
Your personal data will not be transferred to any other person or organisation and will be deleted from club records one year after your membership of Disability Club has terminated.
You have the right to request from Disability club access to and rectification of your personal data. If you feel that your personal data has been misused you have the right to complain to the Information Commissioners Office.

Membership Form

If you do not wish to fill in the form online, but are still interested in coming to the club, then you can just turn up on a Wednesday Evening between 6:30pm and 7:00pm.
We will require a membership form to be completed a copy of the form is below.

Membership Form

Membership Application Form

Please enter details for all fields marked*.

Firstname:* Lastname:* Address:* Town:* County:* Post Code:* Email*: Phone Number:* Mobile Phone: Ring&Ride Number: Comments: