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TCBC Membership Application Form

Please Print Clearly: (Print and complete this form and mail to TCBC)

Name ______________________________________________________

Address _________________________________________ Apt.#______

City ________________________________________________________

State _______________________________ ZIP ____________________

Birth Date _____________________________ Gender: M_____ F______

Evening Phone (_____) ________________________________________

Email ______________________________________________________

* list the first and last names of other bicyclists in your household (such as spouse, children, etc):

1. Gender: M___ F___ Birthdate __/__/__ : ____________________________________

2. Gender: M___ F___ Birthdate __/__/__ : ____________________________________

3. Gender: M___ F___ Birthdate __/__/__ : ____________________________________

Membership Categories & Fees:

.	Please circle Amount Paid
.	SINGLE	$25.00
.	HOUSEHOLD	$35.00

___ Contact me about TCBC Volunteer opportunities.

Make checks payable to: TCBC (Please do not staple checks.)
Mail this completed form and your check to:

Twin Cities Bicycling Club - Membership
P.O. Box 131086
Roseville, MN 55113