Pensacola Off-Road Cyclists

*On-line Application Form*

(if capacity full -- please complete form, and copy and paste into email to porc@porc.org otherwise use the submit button.)

Please complete the PORC Membership Application Form below. If you are renewing your membership, and your address is still current, you need not complete the address section. However, those fields with an "*" must be filled out. By completing this form, you are promising to follow-up with payment of membership dues within 10 days of submittal of form. Once we have received your application, we will contact you via e-mail with information about your membership.

* Type of Membership

New Membership

Renewal

______________________________________

* First Name

* Last Name

* Year of Birth

Address

City

State

Zip

Phone

* E-mail Address

* Make / Color of Bike(s)

* Emergency Contact and Phone Number

_____________________________________

Are you currently a student or alumni of any college or university in the State of Florida?

Student

Alumni

No

______________________________________

* Membership Type

Additional Family Member Names / Age

______________________________________

* Your Riding Abilities:

* Types of Riding You Prefer (click all that apply):

Club Activities You Would Be Willing to Help With:

* Payment Method

I am going to pay with PayPal (preferred)

I am going to pay by mail (address will be provided after you submit the form)

______________________________________

* Would you be interested in receiving promotional information from some of PORC's Sponsors?

Yes

No

______________________________

ALL MEMBERS MUST READ AND AGREE TO THE CONDITIONS BELOW:

* I realize the sport of mountain biking can be dangerous. I will not hold PORC or its officers liable for any loss of life or limb, injuries or property damage. I will abide by PORC and IMBA's Rules of the Trail, and all other club and Local Govermental and Institutional Laws, Rules, Policies, and Authority.

Agree

* Indicates Response Required