Membership - Vancouver Velo Vets Cycling Club

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						 																Velo                                                                              Vets
	 	 																
                                               2011
                                               2010	Membership	Application	Form

First	Name:																																																																														Last	Name:																																																															
Address:																																																																																		City:																																																						Postal	Code:
Phone:																																																																																					Cell:																																																																										
Email:
Date	of	Birth:																																																																											Male																																																						Female




Velo	Vets	Membership	Renewal	-	$60.00												New	Membership	-	$130.00	(includes	jersey)                                                                          $
Additional	Membership	with	same	address	-	$30.00								Additional	New	Membership	-	$100.00	(includes	jersey)                                                        $
                                                                                   $36.00
MANDATORY	Cycling	BC	Membership	Insurance	(unless	purchased	through	another	club)	-	$32.00                                                                           $
Affiliate	Fee	for	riders	with	valid	Cycling	BC	Ins.#_______________	(purchased	through	another	club)	-	$10.00                                                        $

Racing-licensed	riders	exempt	from	additional	fees.	License	#________________


CLUB KIT (circle size)
Club	Jersey	-	$70.00																																			S										M										L										XL										XXL										Quantity__________                                  $
                  $115
Club	Bib-Shorts	-	$90.00																													S										M										L										XL										XXL										Quantity__________	                                   $
Club	Vest	-	$80.00																																							S										M										L										XL										XXL										Quantity__________	                               $
Club Shell - $130
Arm	Warmers	-	$30.00																																S										M										L										XL										XXL										Quantity__________                                     $
Club Knickers - $115
Skin	Suit	-	inquire																																								S										M										L										XL										XXL										Quantity__________                              $
                155.00
Winter	Jacket	-	inquire																																	S										M										L										XL										XXL										Quantity__________                                 $


                                                                                                                              Total amount submitted: $


Do	you	give	consent	for	the	publication	of	your	contact	information	within	the	Vancouver	Velo	Vets	Cyvling	Club	Mem-                                                 Yes																										No			
bers	Directory?	Distribution	is	limited	to	members	only.
Do	you	want	to	receive	the	Cycling	BC	email	newsletter?                                                                                                              Yes																										No



                                                           Make	cheque	payable	to:	
                     Vancouver Velo Vets	and	send	with	this	completed	form	and	the	completed	and	signed	Waiver Form	to:	
                                                              Jim Henderson
                                               424 Trinity Street, Coquitlam, B.C. V3K 5N3


                                                                                        - IMPORTANT -
                    To	avoid	race	cancellations	due	to	a	lack	of	marshalls,	etc.	racing	members	of	the	Velo	Vets	are	required	to	
                            volunteer	(or	if	racing	provide	a	volunteer)	for	all	races	conducted	or	sponsored	by	the	club.



                             Vancouver	Velo	Vets	Cycling	Club	~	www.vancouvervelovets.org	~	velo@vancouvervelovets.org

				
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posted:8/12/2011
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