ERDBA Club Registration Form
2021
Email address *
Club Name *
Website *
Address (including City, State, Zip) *
Club's ERDBA Representative - The ERDBA Representative is a person who is authorized to represent the club and vote on ERDBA matters. *
Representative Phone *
Representative Email *
Secondary Contact Name - the Secondary Contact will only be authorized to vote if the primary representative is not available *
Secondary Phone *
Secondary Email *
Club Teams: List your teams and their race divisions for the 2020 race season *
Once above application is completed please date below. If you DID NOT pay your 2020 membership fee, Then make check out to ERDBA for $300 ($330 if not postmarked by January 31, 2020) to Heather Sullivan, Treasurer ERDBA, PO Box 446, New Hope, PA 18938-0446 or pay via PayPal ($10 processing fee) at www.paypal.me/erdba/310 *
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A copy of your responses will be emailed to the address you provided.
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