USDCA MEMBERSHIP APPLICATION

    Membership is open for all athletes, coaches, friends or sponsorships. Five-dollar due is to be good for one year. Upon the receipt of due payment, you will have the privilege of being a member of the U.S.D.C.A. and a subscriber of the BREAKAWAY newsletter three times annually (usually winter, late spring and fall). The objectives of the BREAKAWAY are to keep members well informed about how they are getting along with their training progress & accomplishments, to feature some riding techniques, to present any results of competition around this nation and world, on aspects of deaf cycling, and much more.

    Please print this page and fill out the form clearly. Send it along with the check payable to USDCA to:
            Bobby Skedsmo, USDCA Secretary-Treasurer
            247 Jack London Ct
            Pittsburg, California 94565-3661

    Name:___________________________________________________________

    Address:_________________________________________________________

    City:___________________________ State:_______Zip Code:_____________

    E-mail:_________________________________________________________

    Please circle your current membership::

          (a) | New | Renewal | Renewal after several years |

          (b) | Competition | Recreation | Coach | Sponsor | Friend | Organization |


    For those who are interested in race and/or be on the team, please fill the blanks below:

        Weight:_________ Height:__________ Birthdate:_________________________

        School: _________________________________________________________

        College: ________________________________________________________

        Occupation: _____________________________________________________

        United States Cycling Federation:  no ( ) yes ( )     NORBA:  no ( )  yes ( )

        Cycle Club: _____________________________________________________

        Junior ( )  Senior ( )  Masters ( )  Category (5)  (4)  (3)  (2)  (1)