Address:________________________________
________________________________
________________________________
Telephone: Home:_____________________
Work:_____________________
E-Mail address:_________________________________
USCF License Number:__________________Racing Category__________
Racing Age:_______ Years Racing:_________
What are your goals this season?________________________________
________________________________________________________________
________________________________________________________________
What are your cycling strengths?________________________________
________________________________________________________________
________________________________________________________________
What are your cycling weaknesses? ______________________________
________________________________________________________________
______________________________________________________
Are your interested in assuming some responsibility within the Club?
____yes ____no
If so, in what areas are you interested in?_____________________
________________________________________________________________
Are you interested in working with Juniors or new cyclists?
____yes ____no
Do you want to be placed on the phone chain to be notified of races, meetings, and club events?_____yes ____no
______________________________________________
Signature Date