Membership Application
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Your Information
First Name
Last Name
Email Address
Address
City
Postal Code
Phone
Alternate Phone
Date of Birth
Gender Male   Female  
Membership type
Racing Category

Emergency Contact
Name
Relation to Rider
Phone

Survey
What are your riding interests? Recreational   Racing
Road   CycloCross   Track   MTB  
How often will you participate in rides? Daily   Weekly   Occasionally   Special Events Only  
How many years have you been cycling? New rider   1 - 2   3 - 5   5 - 10   10+  
How did you first learn about the Club?
What attracted you to join the Club?
MBRC is a volunteer run organization
What skills can you contribute to the Club?