Allegheny Cycling Association

2013 ACA Membership Form

Register online by filling out the form and clicking the "Register Now" Button.
Please fill in all fields and wait for a "thank you" confirmation screen! You will be billed later by email.
OR

Print it on your printer (click here for a printable version) and send it along with your payment by US mail to:

Allegheny Cycling Association
305 North Pasadena Drive
Pittsburgh, PA 15215

ACA memberships are valid on a calendar year basis (January 1-December 31). All ACA memberships expire on December 31.

Unless the team you race for is a registered USAC club (such as Freddie Fu Cycling, etc.), please make sure you add "Allegheny Cycling Association" as your affiliated club on your annual USAC license. Make sure you spell it out in full, and don't add your local team (such as Cycleworks, etc.) or you license may come back marked "Unattached". This is important to you and the ACA in receiving distributed USAC funds.

Wrench:

Name:

Address:

City:

State:

Zip Code:

Phone:

Racing Age:
(As of 12/31/2013)

Email:

USAC License Number:

USAC Cat: Pro Cat 1 Cat 2 Cat 3 Cat 4 Cat 5 None

Team:

Other Club
Affiliation
(Freddie Fu Cycling, etc.):

Medical
Insurance:

Person to Call
in Case of
Emergency:

Phone:

Cell:

Membership: Individual $35 per year Family $45 per year

Additional
Family
Members:

Comments:

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