New Member Application

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Name and Address

First

Last

Name(s)

Address

City

State

Zip Code

Membership Expiration Date:

Date of Birth

MM/DD/YYYY, e.g., 06/21/1967

Home Phone	Enter as XXX-XXX-XXXX, e.g., 603-555-1212
Work or Cell Phone	Enter as XXX-XXX-XXXX, e.g., 603-555-1212
Email Address

I would like to receive my monthly issue of Wheel People as
(See WheelPeople page for details.) Paper delivery $15 additional.

Membership Type:

Optional Information

Sometimes we allow bicycle related companies the use of our membership list.

May we make your name available to these companies? Yes No

I would like to assist CRW in the following activities:

Rides (lead, co-lead, arrow) Social Safety Special events(Centuries)

Other

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I (We) have read and agree to the terms of the Release Forms.
Your membership application will not be processed unless this box is checked.

If any individual described on this application is between 16 & 18 years of age, please fill out and mail a Release Form for Minors to:

Linda Nelson
65 Hillside Ave.
West Newton, MA 02465

Check if this is a gift membership

NOTE: This form is intended for new members only. If you are a renewing member, please complete the renewal form that was mailed or emailed to you, or fill in the online renewal form.

If you did not receive an email and your membership is due to or has expired, please contact our membership staff.