Texas Bike Coalition

www.SuperCyclist.org
www.SafeRoutesTexas.org

Texas Bicycle Coalition
P.O. Box 1121
Austin, TX 78767

Phone: 512.476.RIDE (7433)
Fax: 512.476.7458
mail@biketexas.org

This Form Is Encrypted And Secure!
Your personal information will not be sold to third parties.
If you have any problems using this form, call (512) 476-7433 to join by phone.

Membership & Contribution Form

Use this form to:

Join as a new member,
Renew your membership,
Volunteer, or
Make a contribution.

* Please fill in each of these fields!

CONTACT INFORMATION

* Last Name:
* First Name:
2nd name (for joint members only):
* Mailing Address:
* City:
* State:
* Zip Code:
Texas County:
* Home Phone:
Work Phone:
* Email Address:

MEMBERSHIP INFORMATION
(If you are making a contribution only, skip to the Contributions section below.)

I am a:

New Member
Renewing Member

Indicate the membership level you'd like to join:

$25 Individual
$35 Joint/Family
$50 Sponsor
$100 Patron
$500 Life Member

If your membership level is $50 or greater, select your free premium!

Black TBC ballcap with red logo
Cycling socks, women's small (size 5-8)
Cycling socks, women's medium (size 8 1/2 - 10 1/2)
Cycling socks, men's medium (size 7-9)
Cycling socks, women's large (size 9 1/2 - 11 1/2)
Cycling socks, men's large (size 11 1/2 -13)
Keep the premium!

CONTRIBUTION INFORMATION

Contribution for TBC advocacy (non-tax deductible)	$
Contribution for TBCEF education programs (tax-deductible)	$

I am making this contribution for:
Phyllis Hassan Memorial Share the Road license plate fund Larry Schwartz Memorial

TRACKING INFORMATION

How did you find www.biketexas.org?

TBC newsletter, BikeTexas Today
Email / Listserve message
Appeal Letter
Another Web site:
Search Engine:
Newspaper Article:
Other:

YOUR CYCLING INTERESTS

Bike club(s) to which you belong:
I enjoy these kinds of cycling (check all that apply:	Touring Commuting Off-Road Racing Messenger Recreation Fitness Utility

PAYMENT INFORMATION
(To pay with check or money order,
please use the printable form or call 512-476-7433.)

Bill my credit card:

VISA
MasterCard
Discover

Total Amount:	$
Card Number and Expiration Date	/

VOLUNTEER INFORMATION
(Visit the Volunteer page for descriptions of tasks.)

I would like to help with:
Office work
Media watch
Newsletter
Regional representative
Event representative
Other