Fun Cycling UG Membership Registration Form

Fun Cycling UG Membership Registration Form

Complete the form below to sign up for our membership.
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Names:

TitleFirst NameMiddle NameLast Name
Birth Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex
Occupation/Proffession:
Phone Number 1:
Format: (000) 000-0000.
Phone Number 2:
Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Current Health Issues:
Blood Type:
Next of kin

TitleFirst NameMiddle NameLast Name
Phone Number of Next of kin:
Format: (000) 000-0000.
Where did you hear about us?

Other
Membership Rules
1. Membership is available to anyone 18 years of age or older.

2. You promise NOT to use to conduct any fraudulent or business activity or have more than one Member Account at any time.

3.Registration fees of 20.000/-ushs shall be submitted to the Club.

4.Annual Subscription of 200.000/-
Email
example@example.com
Privacy Policy
Please reach out and read our Privacy Policy in order to understand how your information is used and shared, and check below if you accept the policy.
Date of Application:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Membership Rules