BCBC Application/Renewal Form
01/31/2019
 
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: 5 digits only
* Gender: Male    Female
* Age on day of race:
* Date of Birth: MM/DD/YY
* 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
Would you like to be a Ride Host/Hostess? Yes    No
Are you interested in Road rides , Trail rides or both?
Would you like to help with Social events?
Parent/Legal Guardian Name (required if under 18 on day of race):
 
Race(s)
New Applicant at : ( $20.00 plus $1.25 service fee through 01/31/2019 )
  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 : ( $20.00 plus $1.25 service fee through 01/31/2019 )
  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

  Premium to be received by all preregistered runners: NONE



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