USDCA MEMBERSHIP APPLICATION

Cycling enthusiasts, friends or sponsors may become members by paying five dollars per year. Membership entitles you to be member of USDCA and a subscriber to the Breakaway and eBreakaway newsletter. 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 fill out and submit the form. Upon receipt of the due payment, we will validate your membership immediately. Please write a check of $5 payable to USDCA at:

          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)