Membership : Mountain Top Cycling Club

Membership

There are two levels of membership for MTCC – $25 individual, or $40 family. Please fill out the form below in it’s entirety. Upon clicking “Register Now!”, you will be presented with an option to pay for your membership via PayPal. Alternatively, you can download, fill out and mail the Membership Application Form (PDF file).

Name *

Date of Birth *

Address *

City *

Zip Code *

Home Phone *

Cell Phone *

Any Medical Conditions?

Emergency Contact/Phone *

Are you willing to be a volunteer?

Yes, I am!

How do you want to be notified?

Phone

Primary Email (for club mailings) *

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Option 1

Option 2

Release

In signing this release, or submitting payment online, for myself or for the named applicant, I agree to absolve all of the sponsors, organizers and associated entities, be they individuals or organizers, singly or collectively, of any injury or misadventure suffered as a result of taking part in any activities associated with or related to the Mountain Top Cycling Club.

Signature *

Date *

Membership Type *

Individual - $25.00 per Year

Family - $40.00 per Year

Family Membership

Mountain Top Cycling Club

Woodland Park, CO

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