Join the Tacoma Wheelmen's Bicycle Club

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__________________________________________________________
Name (please print)

__________________________________________________________
Street address

__________________________________________________________
City / State / Zip Code

Phone (Home) (______) ________________ (Work) (______) ________________

E-mail address _____________________________
[ ] New Member [ ] Renewal [ ] Address Change

Please check your activity of interest:

[ ] Leading Rides [ ] Special events [ ] Newsletter [ ] Meeting Programs

Individual Membership $15 _____________
Family Membership $20 _____________
One-time initiation fee for new members $ 5 _____________
Total _____________

Send this form with your check to:
Tacoma Wheelmen's Bicycle Club
PO Box 112078
Tacoma, WA 98411 [ ] Check if you do not want your phone number and address included in club listings.