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Membership App New CX 2016v3

The document is an application form for an Oregon Bicycle Racing Association (OBRA) cyclocross license. It requests basic contact information from applicants, date of birth, club or team affiliation, preferred racing category, and payment of annual membership fees. OBRA uses the licenses and fees to support and promote bicycle racing in Oregon by assisting race promoters and racers.

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Tracy Ross
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55 views1 page

Membership App New CX 2016v3

The document is an application form for an Oregon Bicycle Racing Association (OBRA) cyclocross license. It requests basic contact information from applicants, date of birth, club or team affiliation, preferred racing category, and payment of annual membership fees. OBRA uses the licenses and fees to support and promote bicycle racing in Oregon by assisting race promoters and racers.

Uploaded by

Tracy Ross
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OREGON BICYCLE RACING ASSOCIATION

Cyclocross License Application


Complete the following information
Fees:
Todays Date:________________ PRINT CLEARLY
Adult membership r $20
Name:__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Juniors 18* & under r $10
Mailing Address: __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| *age as of 12/31 of
current year.
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
City __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Optional Donation to
OBRA- Your donation
State __|__| Zip __|__|__|__|__|__|__| Country __|__|__|__|__|__| is tax deductible.
$
Contact Phone (__|__|__|)__|__|__|__|__|__|__| Mo/Yr of Birth __|__|__|__|
Email __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Club/Team __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Total $ ________
Occupation ____________________
If you wish to use a credit card
If you were a member last year, do you have your plastic membership card? please sign up online.
r Yes r No
Help OBRA save money and trees. Would you like to receive mailings in electronic
format? r Yes r No (If yes, make sure your e-mail is legible)

Questions? E-mail membership@obra.org or visit try.obra.org


CYCLOCROSS CATEGORY

You are racing: r Men r Women

r1 r Masters
r 2 (A) r Juniors
r 3 (B) r Single Speed
r 4 (C) r Clydesdale/Athena
r 5 (Beg)

If this is a new membership, you will be assigned as a Cat 5. Send the completed form along with a check payable to
Juniors 9-11 may not race at the same time as adults. OBRA to:
Please have them race the Junior Cyclocross Series. You
may not self-select to 1 or 2s. OBRA Membership
P.O. Box 5773
Your cyclocross racing age is your age on December 31, Salem, OR 97304
2016. Memberships are non-refundable.
or sign up online:
Your membership expires the last cyclocross race of the 2016 www.obra.org
season.
Interests: r Volunteer r Official r Race Promotion r Joining a Team
JOIN THE OREGON BICYCLE RACING ASSOCIATION AND HELP SUPPORT THE SPORT OF BICYCLE RACING IN
OREGON. OBRA HELPS YOU BY PROVIDING SUPPORT TO BICYCLE RACE PROMOTERS AS WELL AS RACERS.

For Official Use Only: Fee paid: $ _______


CX # ________ Rev. 8.22.16

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