Membership Form

After completing form, PayPal provides options to use debit or credit card or your PayPal account.

New or Renewal Membership?(Required)

New

Renewal

Membership Level(Required)

Individual

Household

Student

CCB Member

Bike Project Member

Wild Card Cycling

Household Upgrade

Total

Name(Required)

For Primary Contact

First Last

Household Membership Additional Name

Additional name for Household Level Membership

First Last

Email(Required)

For Primary Contact

Enter Email Confirm Email

Address(Required)

For Primary Contact

Street Address City State ZIP Code

Waiver and Release(Required)

In joining the Prairie Cycle Club, I/we acknowledge that bicycling in and of itself can be dangerous, and hereby release and waive all claims against the Prairie Cycle Club (PCC), PCC members, PCC officers and directors, and successors and assignees, for damages resulting in injury either to myself or to my equipment, during any and all PCC-sponsored events. Helmets are strongly recommended for all PCC- sponsored bicycling activities and for all bicyclists.

I agree

Payment Method

PayPal will provide option to pay with credit/debit

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

PCC Membership Dues

After completing form, PayPal provides options to use debit or credit card or your PayPal account.