Edenglen Cycling Club Membership Registration Form

Edenglen Cycling Club Membership Registration

Complete the form below to sign up for membership.
Please select your type of membership:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate / Emergency Phone Number

Please add the name and number of your emergency contact person.
Emergency Contact Name

First NameLast Name
Alternate / Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Aid Details

Please note that these details will only be used in case you are in an emergency during any of our cycling events.
Medical Scheme Name
Medical Aid Number
Membership Fees and Cycling Jersey Order Form
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Membership Fees - 2026
Membership fees for 2026.

750.00 ZAR Quantity
Item subtotal:0.00 ZAR



Pensioner Membership Fees - 2026
Pensioner Membership fees for 2026

450.00 ZAR Quantity
Item subtotal:0.00 ZAR



Student Membership Fees - 2026
Student Membership fees for 2026

350.00 ZAR Quantity
Item subtotal:0.00 ZAR



Cycling Jersey
850.00 ZAR QuantitySizeColour
Item subtotal:0.00 ZAR



Support Driver
500.00 ZAR Quantity
Item subtotal:0.00 ZAR



Total

0.00 ZAR
Thank you for updating your membership details with us. We look forward to another year of great cycling with you.

Thank you!
Thank you for submitting your application, one of the committee members will contact you shortly to welcome you.

Thank you!
Should be Empty:

Edenglen Cycling Club Membership Registration

Alternate / Emergency Phone Number

Medical Aid Details

Membership Fees and Cycling Jersey Order Form*

Membership Fees and Cycling Jersey Order Form