Membership Application

Name _________________________________________________________

Address ________________________________________________________

City _________________________ State ________ Zip _________________

Email* ____________________________________________

Are you a new or renewing member? ___ new ___renewing

What City Council District do you live in?

____ District A - Jay Batt
____ District B - Renee Gill Pratt
____ District C - Jackie Clarkson
____ District D - (formerly) Marlin Gusman
____ District E - Cynthia Willard-Lewis
____ Don't know/Not sure

Membership Level

_____ "Cruiser" - general membership - $10
_____ "Racer" - generous membership - $50
_____ "Tandem" - corporate or partner membership - $75
_____ Suprise us! - $_____________

Please make your check out to Metro Bicycle Colation and mail it to:

Metro Bicycle Coalition
PO Box 19371
New Orleans, LA 70179

* Email is our primary means of communicating with our members, especially during urgent action campaigns. We usually send out only a few postings every month. Metro Bicycle Coalition respects its members privacy and does not share any personal information about its members with other organization or companies.

Thank you for your support!

Back to MBC home page