Club Membership Application Information Name: Age: Address: City: State: first second third Zip: Phone (H): Phone (W): E-mail Address: Are you a member of the USCF or NORBA USCF license number: Category: NORBA license number: Category: What type of cycling interests you? Mountain Biking Touring Road Racing Track Multi-sport Trials How did you hear about the SVVC? How many miles do you ride a week? Year? Time you normally go on training rides: Level of Membership? Individual: $25.00 Junior: $10.00 College Student: $15.00 Family: $35.00 High School: $10.00 Make checks payable to the "Susquehanna Valley Velo Club" Mail to: Susquehanna Valley Velo Club P.O. Box 51 Williamsport, PA 17703