New Membership Form

(Current members, please use login to member services and renew your membership from there)

First Name:

(required)

Last Name:

(required)

Street Address:

City:

State/Prov:

Postal Code:

Country:

Sex:

(required)

Home Phone:		Check this box if you do not want your home phone number to be published on the internet roster available to members.
Work Phone:
Fax:
Mobile Phone:

Email Address:

(required)

Date of Birth (mm/dd/yy):

(required)

Choose a password for access to the Veloce web site:

(required - 4 characters or more)

Business Information (While not required this information will assist us with assessing our membership profile. You cooperation is greatly appreciated.)

Business Name:

Industry:

Title:

USAC License Number:

Road Category:

Mtb. Category:

Track Category:

Annual Dues For Year 2008: $45.00

By clicking on the button above you will be taken to our secure server where you can pay your membership dues by Mastercard or Visa.

Your membership will be activated as soon as the credit card transaction is authorized.