WCC Membership Application
Step 1 of 3: Personal Information

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Membership application has three steps:

1. Personal information: Fill in everything that is required. Please DO NOT print and mail this form.
2. Payment: You can pay using Paypal. You can also mail a cheque after filling in this form.
3. Waivers: This requires paper forms. We'll give you a link to download them and an address to mail them to.

Items highlighted with a red asterisk * are mandatory.

Note: Registration with the Ontario Association of Triathletes (OAT) requires a separate form and process.  Instructions are contained in Step 3.

Personal Information

First Name *
Last Name*
Address*
City*
Province
Postal Code*
Phone*
Email
Emergency Contact*
Emergency Phone*
Date of Birth*
Member Type* Multisport refers to triathletes & duatheles	Returning Member New Member Returning Multisport Member New Multisport Member
Member Number	(Returning member: stated on your Membership card)
Ride Interests	Road? MTB? Tri? Track? Cross? BMX? Freeride? "Other?"
Type of Membership* Current OCA insurance fee: $25.50 Current OAT insurance fee: $35.00   Clothing choice indicates your preference on the next custom order. Please note that for 2007 shorts are not included with full membership.         Clothing choice indicates your preference on the next custom order. Please note that tri-shorts are shown for comparison. Tri-shorts are not included with membership.	$65 Basic ($39.50 Club + OCA fee) $125 Full ($99.50 Club + OCA fee, includes clothing choice below) $35 Student ($9.50 Club + OCA fee) Elementary, High School, University $70 Multisport Student ($9.50 Club + OCA + OAT fees) Elementary, High School, University $100 Multisport Basic ($39.50 Club + OCA + OAT fees) $160 Multisport Full ($99.50 Club + OCA + OAT, includes clothing choice below) Cycling Clothing Multisport Clothing Click links below to expand list and make your jersey choice Current equipment choice: none Jerseys Short Sleeve Unisex Small Medium Large XL XXL Long Sleeve Unisex Small Medium Large XL XXL Shorts Men/Unisex 3D insert Black Small Medium Large XL XXL Women Black, Infinity insert Small Medium Large XL XXL Multisport Sleeveless Jersey Women Small Medium Large XL XXL Men Small Medium Large XL XXL Tri Tank Women Small Medium Large XL XXL Men Small Medium Large XL XXL Multisport Shorts Women Small Medium Large XL XXL Men Small Medium Large XL XXL Shrink menu
Payment Method*	Cheque  PayPal
Insurance Waiver deduction. Your final fee will reflect a deduction according to the current OCA insurance rate. For these choices, please 'Submit' only in Step 3. Do not download waivers.. Multisport: Step 3 contains a link for the OAT form.	OCA registered UCI License Multiple Club registered (Please include in Comments which other OCA-affiliated Club you are registered with).
Comments, Special Instructions, Special Needs, etc. (shorts upgrade to bib shorts please indicate here).	(255 characters max)

 I'm interested in Volunteering

Privacy Waiver*

In accordance with the Personal Information Protection and Electronic Documents Act I hereby consent to the Waterloo Cycling Club's collection and/or possession of all personal information set out in this application form as well as any personal information which I may have previously provided to the Waterloo Cycling Club or inputted into the Waterloo Cycling Club's internet website. I hereby consent to the Waterloo Cycling Club's use of this personal information from time to time to advise me of activities and meetings of the Waterloo Cycling Club, to contact an appropriate person in the event of an emergency or accident affecting me and to apply and enforce any by-laws of the Waterloo Cycling Club. In addition, I hereby consent to the Waterloo Cycling Club disclosing such personal information from time to time to the Ontario Cycling Association and other bodies affiliated to that agency, including its insurers, or to others when it is required or permitted by law. By my execution of this application for membership, I hereby consent to these uses and disclosures of my personal information. The undersigned by executing this application below hereby applies to become a member of the Waterloo Cycling Club from April 1st of the current year to March 31st of the following year. In consideration of the Waterloo Cycling Club accepting my application for membership, I agree to abide by all by-laws of the Waterloo Cycling Club and general rules of conduct as may be established from time to time by the Waterloo Cycling Club or its Board of Directors and to further abide by all regulations and requirements of the Ontario Cycling Association, the Canadian Cycling Association and the Highway Traffic Act (Ontario) during my participation in all Waterloo Cycling Club activities.

I agree with the above terms*.