Tri-County Bicycle Association
Membership Application
Please print when filling out application. Photocopies accepted.
Saturday, July 31, 2010
Name(s)
Birthdate
Birthdate
Address
City
State
Zip
Phone (with area code)
E-mail
Children
Birthdate
Birthdate
Birthdate
Would you like your name listed on a public club membership roster?
Yes
No
Type of membership:
NEW
RENEWAL
Membership Fees
One Year
INDIVIDUAL (age 12 and up)
at $10/year
FAMILY
at $13/year
Three (or more) Year(s)
INDIVIDUAL (age 12 and up)
at $ 8/year
FAMILY
at $10/year
years
TOTAL $
I CAN HELP WITH
Safety and Education
Newsletter
Art/graphics
Program activities
Tour planning
Web site
INTERESTED IN
Tandem
Pannier riding
ATB-all terrain bicycle
Recumbent
Print this form, write your check to "Tri-County Bicycle Association" and mail to
TCBA - Membership
P.O. Box 22146
Lansing, MI 48909-2146
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