The Green Mountain Bicycle Club
2008 Club Membership Application

Today's Date: ______________________

  Select type of membership:
[   ] Single - Under 18
 $10
  [   ] Single- Adult $20
 
[   ] Family
$25
  Have you been a GMBC member in the past?
[   ] Yes        [   ] No
  
 Are you a League of American Bicyclist member?
[   ] Yes        [   ] No
  
     
  We infrequently get requests from third parties to send
our members info.  Do you wish to receive these items?		 [   ] Yes        [   ] No
  Would you like a GMBC window sticker?
[   ] Yes        [   ] No
  

Please fill out the following for yourself (you will be the primary member):
 Name  
 Address  
 City, State Zip  
 Home Phone  
 Email Address  

Name of Member Year of Birth Sex

USCF Category
(if applicable)

NORBA Category
(if applicable)
<yourself>
        
         
         
         
         

  List emergency contacts (this data will appear on each of your ID cards):    [   ] Check here to use last year's data
 
Name
Relation (optional)
Phone
First: ___________________________________ ______________________ ______________________
Second ___________________________________ ______________________ ______________________

Please answer the following to help us determine activities the club should pursue:
  What are your interests? Check all that apply:   [   ] Touring
[   ] Commuting
[   ] Road Racing		 [   ] Fitness
[   ] Bike Advocacy
[   ] Time Trials		 [   ] Mtn. Biking

[   ] Criteriums
 Would you like to serve on any of the following
committees? If so, select the appropriate boxes:		 [   ] Touring
[   ] Practice Criterium
[   ] Mountain Bike
[   ] Green Mountain Stage Race 		 [   ] Newsletter
[   ] Time Trial
[   ] Public Service
 Would you be willing to volunteer a few hours at the downtown Burlington Criterium on Labor Day?  We need your help to continue to run this popular and long-standing race.  Press to request more info               [   ] Yes       [   ] No

Please make check payable to GMBC and send to:
(Allow 4-6 weeks for processing)		 GMBC, PO Box 492
Williston, VT 05495