United States Deaf Cycling Association

Membership Application

    Cycling enthusiasts, friends or sponsors may become members by paying $5.30 per year. Membership entitles you to be member of USDCA 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.  After you submit the form, you will see the Google Checkout page and pay $5.30 at this time in lieu of stamped letter!  Thank you.

      First & Last Name: 

      Address: 

      City:   State:   Zip: 

      Visual Phone Number: 

      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 submit your membership application at the bottom. 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: