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Annual Membership Registration

Memberships are renewable annually on the first of the month following one year from the date this membership form is received by BikeWalk Virginia.

Thank you for joining BikeWalk Virginia!


Name*
Organization
Title
Address*
Address
City*
State*
Zip*
Email*
Phone*
Fax
* indicates required field

Count me in!
Individual Membership $25
  Family Membership $40
  Student Membership $15
  Business/Organization Membership $100
  Sustaining Membership $200
  Sponsoring Membership $500
        Donation to BikeWalk Virginia $
  Total $.00

This is an Individual Organizational Membership (check one)

Chapter (if applicable):



Tell us about yourself!

(check whatever applies)

I walk    
bike    
hike   
horseback ride   
canoe   
kayak
 I do this on my own   
with a club   
for recreation   
for pleasure   
for health   
for work

 

Please contact me with more information on getting involved:
in local advocacy campaigns    as a volunteer for events    on a working committee

The biggest concern I have is:



BikeWalk Virginia · A 501(c)(3) Organization  · 4801 Hermitage Road, Suite 101  ·  Richmond, VA 23227
(804) 261-0507  ·  Fax (888) 308-9427