United States Deaf Cycling Association

Membership Application

    Cycling enthusiasts, friends or sponsors may become members by paying $5.00 plus 46 cents for Paypal fee (if applicable) per year. Membership entitles you to be member of USDCA and a subscriber to the eBreakaway newsletter.

    Please fill out and submit the form. Upon receipt of the due payment, we will validate your membership immediately.    Thank you.

      First & Last Name: 


      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




      United States Cycling Federation:   Yes  No    

      Class:  Junior  Senior  Master 


      Cycling Club: 

      NORBA:   Yes  No

      Cross Country Category: 

      Mountain Bike Club: 

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