[ Home ] [ Rides ] [ Shoo-Fly Classic ] [ How To Join ] [ History ] [ Club Officers ] [ Cycling/Weather Links ] [ Race Division ]

Up

Print this page, fill out the form below, and mail to:
Bill Barber
Berks County Bicycle Club
89 Irish Mountain Road
Temple, PA 19560

THE BERKS COUNTY BICYCLE CLUB, INC.
Membership Application Form

Name _________________________________________________________ 

Street __________________________________________________________

City ____________________________________ _______________________

State _______________________ Zip ________________________

Phone _______________________

E-Mail address ______________________________________

Please Check One: (  ) New Applicant, or (  ) Renewing Member

May we publish your name, address, and phone number in a club directory?  (   ) Yes, or (  ) No

Please indicate your interest by checking as many items as may apply:

Signature __________________________________________________________________________
                                (If applicant is under 18, parent or legal guardian must also sign)

Dues: $20 per household per year. Renewing memberships are due and payable by March 31st of each year.