Edenglen Cycling Club Membership Registration Form

Edenglen Cycling Club Membership Registration

Complete the form below to sign up for membership. Current members, as we are using a new system, we would appreciate you updating your personal information.
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.
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.
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 - 2025Membership fees for 2025.
750.00ZAR Quantity
Item subtotal:0.00ZAR



Pensioner Membership Fees - 2025Pensioner Membership fees for 2025
450.00ZAR Quantity
Item subtotal:0.00ZAR



Student Membership Fees - 2025Student Membership fees for 2025
350.00ZAR Quantity
Item subtotal:0.00ZAR



Cycling Jersey
850.00ZAR QuantitySizeColour
Item subtotal:0.00ZAR



Support Driver
500.00ZAR Quantity
Item subtotal:0.00ZAR



Total

0.00ZAR
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