Cannonballs Cycling Team New Membership Application
First Name
*
Middle Name or Initial
Last Name
*
Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (home)
*
-
Area Code
Phone Number
Phone Number (mobile)
*
-
Area Code
Phone Number
Emergency Contact #1
*
First Name
Last Name
Emergency Contact #2
First Name
Last Name
Areas of Interest
*
“Ride For Pride" Event Planning
“Trips For Kids" Volunteer
Bicycle Advocacy
Committee (Apparel, Newsletter, Safety, Social)
New Membership Due: $75
Includes a one-time new membership due of
$60
.
Includes the annual membership due of
$15
(per team member).
Family Add-On memberships are available for $15.
The annual membership is effective from January 1st to December 31st.
Membership
*
One time membership ($60)
Annual due ($15)
Family add-on: 1 ($15)
Family add-on: 2 ($15)
Other
Family Add-On #1
First Name
Middle Name or Initial
Last Name
Email Address
Phone Number (mobile)
-
Area Code
Phone Number
Emergency Contact #1
First Name
Last Name
Emergency Contact #2
First Name
Last Name
Areas of Interest
“Ride For Pride" Event Planning
“Trips For Kids" Volunteer
Bicycle Advocacy
Committee (Apparel, Newsletter, Safety, Social)
Family Add-On #2
First Name
Middle Name or Initial
Last Name
Email Address
Phone Number (mobile)
-
Area Code
Phone Number
Emergency Contact #1
First Name
Last Name
Emergency Contact #2
First Name
Last Name
Areas of Interest
“Ride For Pride" Event Planning
“Trips For Kids" Volunteer
Bicycle Advocacy
Committee (Apparel, Newsletter, Safety, Social)
Courtesy Fee
*
Online Transaction ($3)
Amount Due
Enter the message as it's shown
*
PayPal Confirmation
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