|
| Membership Fees: | Single: $20 | Lifetime Single: $150 |
| Joint: $30 | Lifetime Joint: $250 | |
| Junior: $15 | Business: $50 |
Address:______________________________________________
City & State:___________________________________________ County:______________________________________
Zip Code:_____________ Phone Number:___________________ E-Mail:_______________________________________
| Check One: | New___ | Renewal___ | Junior Member___ |
| Check One: | Single___ | Joint___ | Lifetime___ |
| Registered Voter? | Yes___ | No___ |
Type of Bike:___________________________________________
Skills/Contacts (helpful to organization):___________________________________________________________________
Signature:_________________________________ Parent/Guardian Signature (Junior Membership):____________________
Member Since____________________Month
____________Year
***************************************************************************************************
Joint Applicant:
Name:________________________________________________
Registered Voter: Yes___ No___ County___________________
Date of Birth:__________________________________________ Occupation:____________________________________