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WELCOME
Individual Membership Registration
New Member Registration
Please take a moment to fill out this form with your General Information.
Register
Register
Are you a member?
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Full Name
*
First Name
Last Name
Gender
Male
Female
Birth Date
*
January
February
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June
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October
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Month
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Day
2020
2019
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Year
Nationality
*
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Contact Information
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E-mail
example@example.com
Phone Number
*
-
Area Code
Phone Number
Pickup Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
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Choose a file
Passport size photo (Good quality please)
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Upload proof of age
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CLASS
Only competitive, recreational and commuter riders are covered by accident insurance. Select recreational or commuter rider if you are a technical official who also rides.
Select class:
Competitive
Commuter
Recreational
Technical Member (Mechanics & Coaches)
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Choose Category
In order to register as a junior/master or any other age guided category, please calculate your age as at December 31 of the year of registration. (Eg. If you are born 2002, your age for 2020 is 18, regardless of your exact date of birth.)
Choose Category:
Category 1
Category 2
Category 3
Category 4
Category 5
Female Open
Master (40 years & over)
SuperMaster (50 years & over)
Junior Male (16-18 years)
Junior Female (16-18 years)
Juvenile (under 16 years)
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DISCIPLINE:
Select any or all of the disciplines you participate in.
Choose Category:
ROAD
TRACK
MTB
BMX
PARA
TRIALS
CYC4ALL
CYCLO-X
ATHLETE
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Cyclist Signature here
Clear
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Guardian's Information:
Guardian's signature required if the applicant is under 18 years of age
Guardian's Name
First Name
Last Name
Guardian's Signature here
Clear
Guardian's Relationship
Submit
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Re-Registration
Please take a moment to fill out this form with your General Information.
Register
Register
Full Name
*
First Name
Last Name
Gender
Male
Female
Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Nationality
*
Contact Information
We are almost there, please continue.
E-mail
example@example.com
Phone Number
*
-
Area Code
Phone Number
Pickup Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Upload a recent photo of yourself
Browse Files
Drag and drop files here
Choose a file
Passport size photo (Good quality please)
Cancel
of
Upload proof of age
Browse Files
Drag and drop files here
Choose a file
(ID or birth certificate) Passport size photo
Cancel
of
CLASS
Only competitive, recreational and commuter riders are covered by accident insurance. Select recreational or commuter rider if you are a technical official who also rides.
Select class:
Competitive
Commuter
Recreational
Technical Member (Mechanics & Coaches)
Choose Category
In order to register as a junior/master or any other age guided category, please calculate your age as at December 31 of the year of registration. (Eg. If you are born 2002, your age for 2020 is 18, regardless of your exact date of birth.)
Choose Category:
Category 1
Category 2
Category 3
Category 4
Category 5
Female Open
Master (40 years & over)
SuperMaster (50 years & over)
Junior Male (16-18 years)
Junior Female (16-18 years)
Juvenile (under 16 years)
DISCIPLINE:
Select any or all of the disciplines you participate in.
Choose Category:
ROAD
TRACK
MTB
BMX
PARA
TRIALS
CYC4ALL
CYCLO-X
ATHLETE
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm