California Deaf Wheelers

Membership Application

    Cycling enthusiasts, friends or sponsors may become members by paying ten dollars per year.  Membership entitles you to be member of both USDCA and CDW and a subscriber to the Breakaway and eBreakaway newsletter.

    Please fill out and submit the form.  Upon receipt of the due payment, we will validate your membership immediately.  Please write-in "CDW" on the Memo line and send a check of $10 payable to Nancy Bennett at:

      Nancy Bennett, CDW Treasurer
      106 Catalina Drive
      Hercules, California 94547

    First & Last Name: 

    Address: 

    City:   State:   Zip: 

    Video Phone Number: 

    Mobile Phone Number (Text): 

    E-mail Address:   (Required to fill)

    Please check your current membership  

    (a) Renewal  New  Renewal after several years

    (b) Competition  Recreation  Coach  Sponsor  Friend  Organization >

    (c) Which of the following information fits you:

    Stop Here and go to the Submit Button at the bottom of this page.  Thank you!

     

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

    Are you a racing cyclist?   Yes  No

    What bike type?     Mounatin  Road  Both

    Male   Female

    Weight:    Height:    Birthdate:  e.g. 00-00-0000

    School:   

    College: 

    Occupation: 

    United States Cycling Federation:   Yes  No    

    Class:  Junior  Senior  Master 

    Category:  5  4  3  2  1 

    Cycling Club: 

    NORBA:   Yes  No

    Cross Country Category: 

    Mountain Bike Club: 

    Please comment if any question about this application or others given below: