CC Membership Form - Monthly payment

Community Cycles Membership - Recurring Payments

Monthly Amount*

$5 per month (individual) - minimum amount $6 per month (cycling sock incentive) $10 per month (household / tshirt incentive) $20 per month (good karma!) $100 per month (lifetime member)

Other:

Name*

First Name

Last Name

IF household membership ($10/month or more), enter other members of household (names & email)

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Email*

Total

Membership end date

Years to 99

Dec 31, 2099

Subscribe to our monthly enews.

Subscribe to a digital version of the bi-annual Momentum magazine?

Momentum

Do you agree to the below Shop Rules and Membership Expectations?

Closed-toed shoes must be worn at all times if you are working with tools.
Sign-in & check-in with Greeters to receive your reserved workstation.
There is a mechanic on duty. We want to emphasize that you are working on your own bike, with our assistance
Please use only the color-coded tools at your reserved station.
When using the parts washer always wear an apron, heavy gloves and safety glasses.
Dogs are welcome at Community Cycles but they must be leashed at all times.
Put away all tools and bins that you use.
Track All the (new & used) parts that you used on your tab - Reservation Card.

Checkbox*

I accept

Phone*

How do you wish to pay?*

Paypal Credit Card

Selecting Paypal will redirect you to PayPal Standard to complete the payment process and is the preferred Community Cycles method. You can cancel the recurring payments at any time.

Credit Card

Campaign Record Type

Date/Time

Campaign Name

stage