SIPlive: MECCA Bicycle Club (L.?)

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2021 MECCA Mountain Bike Club Membership Registration

New this year! All paid members will be entered into a drawing to be held in

March for a $75 gift certificate to BicycleWerks!

Membership Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Membership Fee:

$20.00

Select:

Item Subtotal:

$0.00

Gender
Age
T-Shirt Size
Bike
Occupation
Hobbies
How would you like to receive your monthy MECCA Newsletter?

Your $20.00 Annual Membership Fee is due each January.

Total:

$0.00

Payment Information:

Processing Fee Rates:
Cards:	2.9% plus $0.30
eCheck (ACH):	$0.49

Method of Payment:
Update Name from Personal/Organizational Information

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

Mailing address if you would prefer to mail in your membership dues:

MECCA

P.O. Box 491

Huntington, UT 84528

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