Membership Form - Shoalhaven Bicycle Users Group

Membership Required*

Membership Type*

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Mobile Phone

Email

Are you a member of Bicycle NSW?*

Bicycle NSW member number*

Expiry Date*

Are you a member of other cycling organisations?*

Please give details

Emergency contact name*

Emergency contact phone*

Do you agree to have your email address included in the SBUG email address group?*

Please indicate below that you have read and agree with the ‘Important Notice - Risk Warning’ shown on the previous page.*

Date

Captcha


Membership Membership Required* New Member Existing Member Renewal Membership Type* Full Member (also a member of Bicycle NSW) Associate Member Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country Phone Mobile Phone Email Are you a member of Bicycle NSW?* Yes No Bicycle NSW member number* Expiry Date* Date Format: DD slash MM slash YYYY Are you a member of other cycling organisations?* Yes No Please give details Emergency contact name* Emergency contact phone* Do you agree to have your email address included in the SBUG email address group?* Yes No Please indicate below that you have read and agree with the ‘Important Notice - Risk Warning’ shown on the previous page.* i Agree Date Date Format: MM slash DD slash YYYY Captcha