Membership Application

Are you a:

Name *

Please enter your first and last name.

Preferred Phone Number *

Please add your preferred phone number.

Alternate Phone Number

Please enter an alternate phone number if you care to

Street Address *

Please enter your street address.

City *

Please enter the City you receive postal mail.

State *

Please select the State you receive postal mail.

Zip *

Please enter your postal Zip code.

Email *

Confirm Email

Please enter your primary email address

Jersey Size

Please enter your Jersey size. You can see a size chart at https://www.pactimo.com/pages/size-chart

Mens or Womens

Bibs Size

Please enter your Jersey size. You can see a size chart at https://www.pactimo.com/pages/size-chart

Mens or Womens

Emergency Contact Name *

Please enter the name of someone we can contact in case of an emergency

Emergency Contact Phone Number *

Please enter the phone number for your emergency contact

Anything you want to tell us?

Before filling out and returning this form please go to www.summitvelo.org and read our membership and dues policies under the Membership Tab.

By submitting this form and my dues payment, I agree to all the terms of the team policies.

Phone

Please mail the appropriate dues (checks payable to Summit Velo) to:

Summit Velo
P. O. Box 31514
Tucson, AZ 85751