Polk Pedalers Bike Club Membership Form
If you have any difficulty with this form, please email treasurer@polkpedalers.com

Thank you for becoming a member of Polk Pedalers cycling club. There's just two steps to complete:
1) Fill out this membership form
2) Pay your dues

Dues can be paid online via debit card at this link: https://cash.me/$MarshallG
Note: Please include your name and "PP Dues" in the note section, for example "Marshall Guthrie - PP Dues"

Dues can be paid by mailing a check to:
Marshall Guthrie
1631 Teton Dr E
Monmouth, OR 97361

For information on other forms of payment, or if you have any questions, please contact the club treasurer at treasurer@polkpedalers.com

Membership runs January 1-December 31. Dues are as follows (2017):
$30 - Couples
$20 - Individuals
$5 - Under 12 years old (on date of payment)

Email address *
First Name *
Your answer
Last Name *
Your answer
Membership Type *
Please select all that apply. You will be contacted after payment to provide additional names for couples and youth memberships.
Required
Phone Contact
Optional.
Your answer
A copy of your responses will be emailed to the address you provided.
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