2024 BCBC Membership Application Form
12/31/2024
 
2024 Berks County Bicycle Club, Inc (BCBC)

Please Register as a Renewing Member or a New Member

Dues are per household per year and renewals should be paid by March 31st of each year

Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter
The BCBC Cycling Times newsletter is published monthly via email to members and on www.berksbicycle.com

In the field below that asks for "Age on Day of Race" please enter your current age
Details and race-day or mailable registration can be found at: http://berksbicycle.com
  
* First Name:   * required fields
* Last Name:
* Street Address:
* City:
* Select a State:
* Zip/Postal Code:
* Gender: Male    Female
* Age on day of race:
* Date of birth:
* Email Address:
Phone:
Best time to call: Day   Evening   Either
Already receiving Weekly Email Run Updates? Yes    No
What kind of surface do you prefer to ride on? Type: Road, Trail, Gravel or All
Enter the Name of another Family Member Rider
Please provide your Emergency Contact Name & Phone Number
How did you hear about Berks County Bicycle Club?
If you would like to help with Social Events (click here)
Parent/Legal Guardian Name (required if under 18 on day of race):
 
Race(s)
2024 BCBC - RENEWING Membership Payment at time of checkout.: ( $20.00 plus $1.50 service fee through 12/31/2024 )
  Dues are per household per year. Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter. The BCBC Cycling Times newsletter is published monthly via email to members and on our web site www.berksbicycle.com
 
2024 BCBC - NEW Membership Signup & Payment at time of checkout.: ( $20.00 plus $1.50 service fee through 12/31/2024 )
  Dues are per household per year. Dues include monthly newsletter and a membership card for discounts at bike shop listed in newsletter. The BCBC Cycling Times newsletter is published monthly via email to members and on our web site www.berksbicycle.com
 
  WAIVER: All riders must sign in at the start of the ride and wear a Snell/ANSI rated helmet. The wearing of earphones is prohibited.
 

Shirt Type
                                                   Size
Club shirt is not included 

Your registration will not be complete until you reach a confirmation screen
that says "you have successfully registered."
Do not close your browser window early or resubmit your entry.
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