New Membership: Personal Information


If you are currently a member and would like to renew your membership, you must log in first. If you don't have a password or you've forgotten it, you may click here and we'll send one to you. Please enter your information below only if you have never been a CRCA member.


Required fields are indicated by "*".
Membership type*:

Donor membership includes club membership, dinosaur status (pre-paid race fees), a club jersey, and the Club will cover your marshalling dates.
Associates have no marshal duties and cannot race in club events.
Associates with Coaching may participate in coaching sessions if they provide a signed CRCA release and a photocopy of a valid USCF license. All other club privileges extend to Associates: monthly newsletter, discounts at some bicycle stores and voting for club officers.
Students must be full-time and under 25. Please send a copy of photocopy of student ID with your signed release.
Email*:
Password*:
Confirm password*:
 
First Name*:
 Last Name*:
Address*:


Country*:
 City*:

State*:

Zip*:
Home Phone*:
 Work Phone:
Mobile Phone:
 Fax:
 
Date of Birth*:
 Gender*:
Occupation*:
 
Emergency Contact Name*:

 Emergency Contact Phone*:
Emergency Contact Address*:
 
I would like to be a dinosaur ($100.00 - all race entries prepaid).
 
I would like to receive the e-mail newsletter. (free)
I would like to receive the snail-mail newsletter. (additional $15)
 
Please do not publish my email address or phone number on the CRCA web site.
 
I would like to make a tax-deductible gift to the Central Park Conservancy: $.
I would like to make a donation to CRCA to expand coaching and rider development: $.
 
If you a male rider with a racing age of 40 or above, and your USCF category is 1, 2 or 3 you have the option of selecting your field for the season:
 
(note: A Jersey is required for new members unless your subteam has one for you. They can be purchased on-line here: www.champ-sys.com/pages/SearchResult.aspx?CategoryID=4.)