2008 Membership Form

Memberships are valid from January 1^st through December 31^st.

______ Individual $35.00 ______ Family $45.00

Please PRINT Clearly

Name __________________________________________________________________

Address ________________________________________________________________

City ___________________ State ___________________ Zip Code _______________

Home Phone Number _____________________ Cell Phone Number______________

Email Address __________________________________________________________

Contact preference for Newsletter & Updates: _____E-mail ______ Regular Mail

Family Memberships

Name _________________________________________ Date of Birth ____/____/____

Name _________________________________________ Date of Birth ____/____/____

Name _________________________________________ Date of Birth ____/____/____

Name _________________________________________ Date of Birth ____/____/____

Name _________________________________________ Date of Birth ____/____/____

(Attach additional sheet with information if necessary)

Signature ______________________________________ Date____________________

Please make checks payable and send to:

Sidney Cycle Association

P.O. Box 374

Dalton, Nebraska 69131

THANK YOU FOR YOUR SUPPORT