philcycling@gmail.com Tel.# 551-9498 Pilot Offfice , mailing address : 5138 Filmore St. Palanan, Makat City.

APPLICATION FOR CYCLING CLUB AFFILIATION 2011

Name of Club / Association _________________________________________________________________
Mailing Address _________________________________________________________________
Contact Numbers _______________________________ Mobile
#_________________________

CLUB OFFICERS : Name Date of Birth

Address
President _____________________________________ ____________
____________________________
Vice President _____________________________________ ____________ ____________________________
Secretary _____________________________________ ____________ ____________________________
Treasurer _____________________________________ ____________ ____________________________
Auditor _____________________________________ ____________ ____________________________
PRO _____________________________________ ____________ ____________________________

Cycling Club/ Association members:

NAME SEX AGE Date of Birth ADDRESS Cycling
Event
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
( Use extra sheet if necessary )

We understand that an affiliation fee for Four (4) years in the amount of 1,000.00 shall be paid in
favour of the PHILCYCLING Integrated Cycling Federation of the Philippines. Upon approval of this
application.

We understand further that the approval of this application binds our CLUB / ASSOCIATION with the
federation and therefore we shall abide the CONSTITUTION and BY-LAWS, and the RULES and
REGULATION of the PHILCYCLING (Integrated Cycling Federation of the Philippines).

Certified by: Noted by:

___________________________________________ ____________________________________________________
Club / Association Secretary Club / Association President

Endorsed by: Recommending Approval:

______________________________________ ______________________________________________
PHILCYCLING Provincial Chairman PHILCYCLING Regional Vice President
 philcycling@gmail.com Tel.# 551-9498 Pilot Offfice , mailing address : 5138 Filmore St. Palanan, Makat City.
PHILCYCLING ( Icfp ) MC Entry no. _______________ DATE __________________________2011