Club | Coastal Cyclists Club

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Membership

First Name *

Last Name *

Email *

Password *

Confirm Password *

Categories *

Individual or Primary Family Member - $35.00

Additional Family Member - $15.00

Who is the primary family member? *

You are joining as an "Additional Family Member". Please tell us the name of the primary family member who paid the full fee.

Country *

Address *

City *

State *

Zip Code *

Phone *

Emergency Contact *

Emergency Phone *

Birthday

Names of family who are joining as add-on members:

You are joining as an individual or primary. If there are other family members joining as "Additional Family Members", please put their names here so we know who the family units are.

What area of town do you typically ride in?

What types of riding do you do?

Gender *

Male

Female

Prefer Not To Say

Waiver *

I have read and agreed to the TERMS *

CLICK HERE TO VIEW THE TERMS.

Is the participant 18 or older? *

18 or older Under 18

Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.

If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.

Parent's signature

Payment Details

Discount or Tracking Code

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Do not COPY & PASTE the code, please type it into this field.

Price

Discount (-)

Credits (-)

available $

Total
no handling

Handling

Total Owed

Payment Method

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Visa

Mastercard

Check

Payable To: Coastal Cyclists
Address: PO BOX 21475, Charleston SC 29413

click the "submit" button to submit your order then send a check to (or pay in person at) the address above.

1. Venmo the total amount to the Phone #:
2. Make sure you enter the code, 41257 in "What's it for".
3. Click the "pay now" button.

Enter a Check Number

Enter a Check Amount

Send email receipt to the participant

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