Membership Information 

To join the PVBC, PRINT this form, fill it out, and mail it to the address below. 

---

Application

NAME __________________________________________ BIRTHDATE___-____-____ 

ADDRESS _______________________________________  

CITY__________________________________ ST ___________ ZIP ________________ 

TELEPHONE ____-_________ CELL PHONE ____-_________ 

EMERGENCY CONTACT ___________ EMERGENCY CONTACT NUMBER ____-____

E-MAIL____________________ 

Dues

Single Membership - - - - - - - - - - $10.00 

Family Membership - - - - - - - - - - $15.00 

Make the check payable to: Palos Verdes Bicycle Club

Mail it with the form to: 

Address

PVBC c/o Perry Shields, Treasurer 
4705 Macafee Road
Torrance, CA 90505-4324