FBA Online Membership Form

Yes! I'd like to join the effort to create a powerful, unified voice for cycling interests statewide. Please sign me up!

I understand the membership will include a subscription to the FBA's quarterly newsletter, the Florida Bicycle Messenger.

Complete this form and then click on a payment option below. You can charge to Visa or MasterCard by mail, or mail in a check.

First Name
Last Name
Nickname or
Preferred Name
Spouse's Name
Address

City
State
Zip Code
County (FL only)
Email Address
Phone
Work Phone
Bike Club Membership
(Bike Club if not listed above)
Have you taken Road I or Effective Cycling class? Yes
Have you taken Road II? Yes
Approximately what year? Where:
Are you a League Cycling Instructor? Yes
Ride Preferences Check all that apply
On-road
Off-road
Touring
Racing
Commuting
Membership Categories:
Individual ($25)
Family/Household ($35)
Student/Living Lightly ($15)
Supporter ($50)
Benefactor ($100)
Legacy ($500)
Sponsor ($1000)
Bicycle Clubs (large) $1.00 per person Amount:
Bicycle Clubs (small/poor) $100
Bicycle Shops/Corporate ($100)

Business or
Organization
(for corporate membership)

For Renewals, FBA Membership Number:
(if you don't know, type UNKNOWN)
NEW MEMBERS LEAVE THIS BLANK
Yes May we contact you about volunteer opportunities? (Please list any special skills or interests below.)

Comments, special skills or interests:

Payment Option

Secure Online Visa / MasterCard
Mail In Visa / MasterCard
Mail In Check

First Name
Last Name
Nickname or Preferred Name
Spouse's Name
Address

City
State
Zip Code
County (FL only)
Email Address
Phone
Work Phone
Bike Club Membership
(Bike Club if not listed above)
Have you taken Road I or Effective Cycling class?	Yes
Have you taken Road II?	Yes
Approximately what year?	Where:
Are you a League Cycling Instructor?	Yes
Ride Preferences	Check all that apply
On-road
Off-road
Touring
Racing
Commuting
Membership Categories:
Individual ($25)
Family/Household ($35)
Student/Living Lightly ($15)
Supporter ($50)
Benefactor ($100)
Legacy ($500)
Sponsor ($1000)
Bicycle Clubs (large) $1.00 per person	Amount:
Bicycle Clubs (small/poor) $100
Bicycle Shops/Corporate ($100)

Business or Organization (for corporate membership)

For Renewals, FBA Membership Number: (if you don't know, type UNKNOWN) NEW MEMBERS LEAVE THIS BLANK
Yes	May we contact you about volunteer opportunities? (Please list any special skills or interests below.)

Secure Online Visa / MasterCard
Mail In Visa / MasterCard
Mail In Check