Registration Form

Print this page out and mail to PO 1827 Bathurst 2795

Select membership type (circle your requirement)
Type Single Family
Life Membership (no need to pay each year)
$30.00 $50.00
Single Year (renewals required each year)
$5.00 $10.00

Member Details
First Name 
Surname 
Address 
Telephone 
Email - Use for Newsletter Y/N 
Member Bicycle NSW?Y/N
Include Details On Secure Web PageY/N(As an aid to communications members will be able to have their details stored on a secure members only area)

Ride Preferences(Indicate what type of cycling you would be interested in)
TypeRoad Touring 
 Off Road 
 Muti Day Rides, Camping 
 Muti Day Rides, Non Camping 
EasyGentle pace and terrain up to 25 km per day 
Easy/MediumSome hills up to 40km 
MediumFaster pace, Up to 50km 
Medium/HardUp to 100km at a brisk pace 
HardUp to 150km at a fast pace 
Other  

Other Comments you may wish to make

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