Yearly Membership – Charlottesville Bicycle Club

New/Renew Membership Step 2 of 3:

New Membership: Use this form to join CBC with an individual 12-month membership (this is the only membership being offered at this time). Supply your name, address and other contact information, including your emergency contact information, and click “Join/Renew Now”. Confirm your purchase by clicking on the “Submit” button to go to Step 3, the secure payment page. NOTE: Each membership MUST be created with a unique email address.

Renewal: Use this form to add 12 months to your membership. Review carefully all your contact information, verify that your emergency contact information is filled in and correct, and click “Join/Renew Now”. Confirm your purchase by clicking on the “Submit” button to go to Step 3, the secure payment page.

NOTE: An asterisk (*) indicates a required field.

Hint: When entering date fields, scroll the page up so the field is near the top of your browser window. This helps the calendar drop-down to function better.

Price:

$30 for 1 Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Phone Number: Phone Number is not valid

Birthday:* Birthday is Required

Primary Emergency Contact Name:* Primary Emergency Contact Name is Required

Primary Emergency Phone Number:* Primary Emergency Phone Number is Required

Primary Emergency Email:* Primary Emergency Email is Required

Secondary Emergency Name: Secondary Emergency Name is not valid

Secondary Emergency Phone Number: Secondary Emergency Phone Number is not valid

Secondary Emergency Email: Secondary Emergency Email is not valid

Rider Class: Rider Class is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

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