Please complete this membership form and email it to fmkyfc2002@yahoo.com or fax it to 603- 615 77432

PEDALPHILES CYCLING CLUB
MEMBERSHIP FORM
1	Name
2	Nick Name
3	Sex	Blood Group
4	Date of Birth
CONTACT
5	Address
6	House Phone
7	Office Phone
8	Hand Phone
9	E-Mail
EMERGENCY INFORMATION
10	Contact
11	Phone