Member Information  (Fields marked * are required.)
Select type of order*	New membership Renew membership I'm already a member. I just want to participate in the Year-Rounder, Ultracycling Cup, and/or order clothing I just want to order clothing
	Membership is a gift from:
Last name*:		Gender*:	Male Female
First name* (middle optional):		Birthdate*:	mm   dd   yyyy
Address-1*:		E-mail*:
Address-2:		Phone:	Ex:(303) 545-9566
City*:		State/Prov*:	** OTHER ** ** SELECT ** AB AK AL AR AZ B.C. BC CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY L4N7C7 LA MA MB MD ME MI MN MO MS MT MW N.C. NC ND NE NH NJ NK NM NS NV NY NZ OH OK ON ONT Ontario OR PA PR Puerto Rico QC RI SC SD TN TX TZ U.S. Virgin Islands UT VA VT WA Washington WI WV WY ** OTHER ** other:
Postal code*:		Country*:	** OTHER ** USA AFGHANISTAN ALBANIA ALGERIA ANGOLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLUMBIA CONGO CONGO (DRC) COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI ISLANDS FINLAND FRANCE FYRO MACEDONIA GABON GEORGIA GERMANY GHANA GREAT BRITAIN GREECE GREENLAND GRENADA GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG SAR HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MADAGASCAR MALAYSIA MALI MARSHALL ISLANDS MAURITANIA MEXICO MICRONESIA MOLDOVA MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NORTH KOREA NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR ROMANIA RUSSIA RWANDA SAUDI ARABIA SENEGAL SERBIA SIERRA LONE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA ST. KITTS AND NEVIS ST. LUCIA ST. VINCENT AND GRENADINES SUDAN SURINAME SWEDEN SWITZERLAND SYRIA TAJIKISTAN TANZANIA THAILAND THE GAMBIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES URUGUAY USA UZBEKISTAN VANUATU VENEZUELA VIETNAM YEMEN ZAMBIA ZIMBABWE ** OTHER ** other:
Yes No	May we publish your address, e-mail and telephone in the membership directory? The membership directory is ONLY published in the UltraCycling magazine.  The information is not published on line or given to other organizations.
Yes No	Racing in RAAM 2010? RAAM riders receive a copy of the crewing handbook:  Crewing with Fuzzy.

Membership
UltraCycling magazine is sent to US members at the special Not-For-Profit rate and is sent Airmail outside the US; hence, the higher membership fees.
For family membership, select type (below) and the number of members (including yourself): 2 3 4
Select type of membership*:				USA	Canada	All Others	Membership fee:$
18 months (7/09 - 12/10):				$50	$65	$80
2010 Annual				$35	$45	$55
2010 Annual Family:				$50	$65	$80
Two Years 2010 & 2011:				$65	$85	$105
Two Years Family:				$95	$115	$135
Three Years:				$95	$125	$155
Three Years Family:				$140	$170	$200
2010 One-Weekend:	event*: ** OTHER ** ** select member type ** ADK - 10 Balltown - 10 Calvins - 10 Central Europe - 10 Davis 12/24 - 10 Desafio - 10 Fireweed - 10 Hoodoo 500 - 10 HoS - 10 Ireland - 10 Metamora - 10 Official - 10 Radmarathon - 10 RAO - 10 Record Attempt - 10 Saratoga 12/24 - 10 Sebring - 10 Slovenia - 10 Tejas - 10 UltraMW - 10 ** OTHER **			$10	$14	$14
2010 Crew (six month):				$20	$30	$40

Participation
Year-Rounder:	$10 to cover awards
Ultracycling Cup:	$10 to cover awards	Participation Fees: $

Family Member #1:
Family Member #2
Last name*:		Gender*:	Male Female
First name* (middle optional):		Birthdate*:	mm   dd   yyyy
		E-mail:
		Phone:
Year-Rounder:	$10 to cover awards
Ultracycling Cup:	$10 to cover awards		Participation Fees: $

Family Member #3
Last name*:		Gender*:	Male Female
First name* (middle optional):		Birthdate*:	mm   dd   yyyy
		E-mail:
		Phone:
Year-Rounder:	$10 to cover awards
Ultracycling Cup:	$10 to cover awards		Participation Fees: $

Family Member #4
Last name*:		Gender*:	Male Female
First name (middle optional)*:		Birthdate*:	mm   dd   yyyy
		Email:
		Phone:
Year-Rounder:	$10 to cover awards
Ultracycling Cup:	$10 to cover awards		Participation Fees: $

Jersey	USA $65 ea      Outside USA $70 ea
Jerseys and Windbreakers are in stock.
Man's (Chest):	S(35-37)	M(38-40)	L(40-42)	XL(42-44)	XXL(44-48)
qty:	0 1 2 3 4 5	0 1 2 3 4 5	0 1 2 3 4 5	0 1 2 3 4 5	sold out
Woman's (Bust):	S(32-34)	M(34-36)	L(36-38)	XL(39-41)
qty:	sold out	sold out	0 1 2 3 4 5	0 1 2 3 4 5			Jersey: $
Windbreaker	USA $70 ea      Outside USA $75 ea
Unisex (Chest):	S(35-37)	M(38-40)	L(40-42)	XL(42-44)
qty:	0 1 2 3 4 5	0 1 2 3 4 5	0 1 2 3 4 5	0 1 2 3 4 5			Windbreaker: $

Tax-deductible Contribution
The UMCA is a not-for-profit educational organization.	$	Contribution: $
Total Fees		Total fees: $
Special Instructions
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