Sierra Express Bicycle Club - Membership Web Form

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To use this form:
  1. Obtain the required liability waiver to print, read, accept, and fill out.
  2. Fill out required and additional fields on this webform. Do not click "Submit" yet.
  3. Print two copies of this webform on paper from your web browser, using landscape paper orientation.
  4. Click on "Submit". If you do not receive a confirming message within 5 minutes at the email address you listed in the webform, correct the email address and resubmit the web form. You may be able to use the "back" button on your web browser to regain the entries you typed on the previous page. (If you do not "Submit" via the web, and you are willing to wait longer for your membership to be processed, simply proceed using postal mail).
  5. Mail one paper copy of webform to SEBC address via postal mail. Include liability waiver and remittance (unless your request is solely for member information revision). Make checks payable to "Sierra Express Bicycle Club". Send postal mail to: Sierra Express Bicycle Club; Membership; 228 Commercial Street PMB 163; Nevada City CA 95959-2507
  6. Keep one copy for your records.
Choose one: (required)
Membership renewal (Must send liability waiver and remittance via postal mail)
New member application (Must send liability waiver and remittance via postal mail)
Member information revision
Information you submit here will be included in the club member roster unless you check "not for roster." The club roster, made available to only club members, has the stated purpose of facilitating social and event contact. It is not intended for any type of commercial use. It will not be published on any web site by SEBC, nor will it be shared by SEBC with any other organization or business. However, SEBC cannot control what its members do with their copies of the roster.
First name: (required)     not for roster  
Last name: (required)     not for roster  
phone: (required)     not for roster  
email: (required)     not for roster
   not for listserve
Your email address will be subscribed to the club email distribution listserve unless you check "not for listserve." The listserve is the best method of receiving information on club rides, events, business, and obtaining the current member roster, because there is no paper newsletter. Your email address will not be published on any web site by SEBC, nor will it be shared by SEBC with any other organization or business.
Information you submit in this section is for internal club administrative use only. It will not be distributed to club members, nor be published on any web site by SEBC, nor be shared by SEBC with any other organization or business.
postal mail address line 1: (required)     
postal mail address line 2:     
postal mail city: (required)     
postal mail zip code: (required)     
remittance dues:      (enter an amount in whole dollars, even if zero) Calendar year dues = $12. If not paid by end January, send $1 for each remaining month, plus $1 for each portion of a remaining month, in the calendar year.
remittance details (NO cash!):      your check number:   
Notes:     
By clicking on the SUBMIT button to send this web form, I affirm my acceptance of all the contents of the club required liability waiver.


 
Form design, implementation and maintenance provided by Nick J (contact info in SEBC club roster)    Web hosting services provided by www.yubanet.com