Infield Request Form

Valley Preferred Cycling Center Infield Pass Request
Full Name

First NameLast Name
Role
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Qualifying Credentials **If you do not have Safe Sport or other clearances please see below the notes section to apply
Qualifying Certification ID Code
If "None" was selected above enter 00 since it is a numbers only field
I understand my application will be reviewed and checked against:• SafeSport Centralized Disciplinary Database (CDD)• USA Cycling Disciplinary Records• VPCC approval requirements
Notes
Free back ground screening is available to Pennsylvania residents.

If you do not have prior clearance please utilize the below resources

Thede respources are free to volunteers

Pennsylvania Child Welfare Portal https://www.compass.dhs.pa.gov/CWIS

Pennsylvania Access to Criminal History https://epatch.pa.gov/home
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Valley Preferred Cycling Center Infield Pass Request