Capital City Cyclists Membership Application
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Means item is required data entry.
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Application Type:
Select One
New Member
Renewing Member
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Membership Type:
Select One
Individual
Family
Partner
Bike Shop
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Date Submitted:
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First Name:
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Last Name:
Partner F. Name:
Partner L. Name:
Children's Names:
Ages:
0-6
7-12
13+
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Street:
Apartment:
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City:
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State:
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Zip:
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Email:
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Phone:
(xxx-xxx-xxxx)
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Road Level:
Select One
NA
EZ Under 12
Slow 12-14
Medium 15-18
Fast 19-21
Racer 22+
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Off-Road Level:
Select One
NA
Beginner
Intermediate
Advanced
Racer
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Newsletter:
Select One
Paper
Read on Web
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Member-Only Online Club Directory:
Select One
Include with all info
Include with name(s) only
Exclude
Ride Interests: check all that apply
Advocacy
BMX
Commuting
Duathlons
Family Rides
Racing
Recumbents
Tandems
Touring
Triathlons
Club Interests: check all that apply
Ride Leader
Social Planner
Board Member
Century Volunteer
Community Volunteer
Newsletter
Enter below any additional information about your interests for the online membership directory:
If a CCC member referred you, please enter that member's first and last name.
Referred By First Name:
Referred By Last Name:
I will bicycle with the Capital City Cyclists on organized or scheduled rides entirely at my own risk. I am completely aware of the risks involved. I will not hold Capital City Cyclists or its officers responsible for any accident resulting in injury or death or damage to bicycle or property while on a bicycle ride with the Capital City Cyclists. The Capital City Cyclists requires that helmets be worn on all rides.
Signature __________________________________________________
Please complete, print, sign and return the application with a check for either $15 for an individual membership or $20 for a family membership. Please make the check payable to Capital City Cyclists, and send it to the following address: Capital City Cyclists; P.O. Box 4222; Tallahassee, FL 32315