Membership Application

The Washtenaw Bicycling and Walking Coalition seeks to increase the quality and quantity of walking and bicycling in Washtenaw County. We pursue our goals through community education, legislative action and cooperation with like-minded groups.

Fill in the required fields (marked in red [*]) and optional information you'd like to share below. We'll reply with a postage paid envelope so you can send us a personal check.

* Full Name:
* Address Line 1:	Street address, P.O. box, company name, c/o
Address Line 2:	Apartment, suite, unit, building, floor, etc.
* City:
* State/Province/Region:
* ZIP/Postal Code:
Phone Number:
Fax:
* Email:
* Membership Category:	Student/Reduced Rate - $10 Individual - $25 Family - $35 Club/Other Organization - $50 Bike Shop - $50 Contributing - $50 Patron - $100
Extra Donation:	$

I WANT TO HELP! I am interested in the following areas:
Public Policy Public meeting attendance, letter writing, legislation, etc. Events Curb Your Car Month, Bike Fest, May Bike Month, July 4th parade, etc.	Education Publicity
Other: