2017 CYCLING CONNECTION MEMBERSHIP APPLICATION
Thank you for your interest in our Club Membership. This application provides our Club with your key information such as emergency contact information, as well as your payment options, etc.

Membership in the Cycling Connection Bicycle Club is open to everyone. Fees for new memberships and renewals are $30*/single and $50*/family. All memberships are for one year and are renewable on the anniversary month. A membership form with the membership fee may be given to one of the Board Members

Checks should be made payable to Cycling Connection. For more info, please contact membership@cyclingconnection.org

*a small fee will be added for online payment

Email address
YOUR PERSONAL INFORMATION
First Name
Your answer
Last Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Contact Phone Number
Preferably a Cell Phone
Your answer
Mailing Address and Zip Code
Your answer
Emergency Contact Phone
Preferably a Cell Phone
Your answer
Emergency Contact Name and Relationship
In the event of an Emergency please list any information you would like the responders to know (health conditions, allergies, medications, etc.)
Your answer
CLUB DATA
How did your hear of Cycling Connection?
Would you like to be involved in the decision making process of the club?
Such as Board Member, Steering Committee, Etc.
Cycling Interests
Some members ride daily, others only on weekends. Some like to tour, some Mountain Bike.
Required
Ride Leaders
We are always on the look out for committed and enthusiastic Ride Leaders. Are you interested in leading rides for other members at your own personal ride level? If so, let us know and we will contact you later.
Who may we thank for your referral, if any?
Your answer
MEMBERSHIP INFORMATION
Membership Type
Select the membership type you are applying for
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