BCBC 2019 Application/Renewal Form
12/31/2019
 
2019 Berks County Bicycle Club, Inc (BCBC) Membership Application/Renewal Form
Dues are per household per year and renewals should be paid by March 31st of each year
Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter
The BCBC Cycling Times newsletter is published monthly via email to members and on www.berksbicycle.com
IN FIELD BELOW THAT ASKS FOR "AGE ON DAY OF RACE", PLEASE ENTER YOUR CURRENT AGE

Details and race-day or mailable registration can be found at: http://berksbicycle.com
  
* First Name:   * required fields
* Last Name:
* Street Address:
* City:
* Select a State:
* Zip/Postal Code:
* Gender: Male    Female
* Age on day of race:
* Date of birth:
* Email Address:
Phone:
Best time to call: Day   Evening   Either
May we may publish your name, address & phone number in a club directory? Yes    No
If you are interested in Road rides - Type: Road
If you are interested inTrail Rides - Type: Trail
If you are interested in Road & Trail Rides - Type: Both
Would you like to help with Social events? Type: Yes/No
Parent/Legal Guardian Name (required if under 18 on day of race):
 
Race(s)
New Applicant at time of checkout: ( $20.00 plus $1.25 service fee through 12/31/2019 )
  Dues are per household per year. Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter. The BCBC Cycling Times newsletter is published monthly via email to members and on our web site www.berksbicycle.com
 
Renewing Member at time of checkout: ( $20.00 plus $1.25 service fee through 12/31/2019 )
  Renewals due by March 31st of each year. Dues are per household per year. Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter. The BCBC Cycling Times newsletter is published monthly via email to members and on our web site www.berksbicycle.com.
 

  WAIVER: n/a

 

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