BCBC 2022 Membership Application Form
01/01/2022
 
2022 Berks County Bicycle Club, Inc (BCBC)

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
Already receiving Weekly Email Run Updates? Yes    No
If you are interested in Road rides - Type: Road
If you are interested in Trail Rides - Type: Trail
Enter the Name of another Family Member Rider
How did you hear about Berks County Bicycle Club?
If you would like to help with Social Events (click here)
Parent/Legal Guardian Name (required if under 18 on day of race):
 
Race(s)
2022 BCBC Membership at time of checkout: ( $20.00 plus $1.25 service fee through 12/31/2022 )
  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: All riders must sign in at the start of the ride and wear a Snell/ANSI rated helmet. The wearing of earphones is prohibited.
 

Shirt Type
                                                   Size
Club shirt is not included 

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