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Membership Renewal Form Name: __________________________________________________________________________________
Please complete the following for any changes or additions: Day Phone: _________________ Evening Phone: __________________ Other: ____________________ Address: _______________________________________________________________________________ City: ________________________________________ State: ___________ Zip: ______________________ Email: ____________________________________ USCF license #: (if applicable) ____________________ Emergency Contact Info: ___________________________________________________________________ New Member(s) sponsored: Name: ____________________________________________________________________________ Name: ____________________________________________________________________________ Name: ____________________________________________________________________________ Name: ____________________________________________________________________________ Name: ____________________________________________________________________________
Payment can be made either by cash or check made payable to Ciclismo SA. TOTAL DUE $ _____________
Mailing Address:
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