On-line Membership Application

Please complete this entire form for both team members and then mail your check made out to Evergreen Tandem Club. Your membership will be activated upon receipt of your check. You MUST click the submit button at the bottom of the form. If you do not see a Success message and/or do not receive an e-mail confirmation immediately, please come back and be sure your email address is correct and then click the submit button again.

This is a change of information This is a membership renewal This is a new membership

First Name   MI 
Last Name
Date of Birth
           Please type 8 digits with no punctuation (mmddyyyy)

Address1

Address2

City State ZIP

Day Phone
Eve Phone

E-Mail address

Usual position: Stoker or Captain

 Available as a captain
 Available as a stoker
 Do not disclose my name to outside mailing lists
 Do not publish my name in the Membership Roster
 I will pass on email updates to someone without access

I would like to help with:
 Leading Rides
 Community Education
 Bicycle Expo
 Tandem Rally
 Club Workshops
 Club Management
 Day rides
 Overnight trips

Please complete this information for the second team member. If you are a single bike or have multiple stokers/captains please check here and skip to the bottom of the form.

First Name   MI 
Last Name
Date of Birth
                                           (mm/dd/yyyy)

Address1

Address2

City State ZIP

Day Phone
Eve Phone

E-Mail address

Usual position: Stoker or Captain

 Available as a captain
 Available as a stoker
 Do not disclose my name to outside mailing lists
 Do not publish my name in the Membership Roster
 I will pass on email updates to someone without access

I would like to help with:
 Leading Rides
 Community Education
 Bicycle Expo
 Tandem Rally
 Club Workshops
 Club Management
 Day rides
 Overnight trips

 We will mail our annual membership check for $25 made out to Evergreen Tandem Club to PO Box 23105, Seattle, WA 98102.

Finally...how did you hear about us? --->> Bike Store Email Expo Friend Web surfing Other

You MUST click the submit button
below to complete the process.