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Application - Print Out

National Bicycle Dealers Association Membership Form

Date:_____________

Name:_______________________________ NBDA Member #_________________

Business Name:______________________________________________________

Street Address:____________________________________________________________

City:__________________________________________State:__________Zip:____

Phone:___________________________________________Fax:_______________

E-mail address:___________________________ Web site:___________________

Description

Price 

NBDA Membership

 

  NBDA Individual Membership (for current retailer employees and managers)

$50

  NBDA Dealer Membership (retailer with physical store and at least 50% revenue related to cycling)

$150

  NBDA Associate Membership “A” (individual, supplier or company allied to the bicycle industry, annual revenue over $1,000,000)

$750

  NBDA Associate "C" membership (individual, supplier or company allied to the bicycle industry, annual revenue under $1,000,000)

$450

  NBDA Additional Store Location & Information "I" membership (store listing and newsletter, for current members only)

$50 each location 

  NBDA donation, Gold Level

$100

  NBDA Donation, Silver Level

$50

  NBDA Donation, Bronze Level

$25

Total Due

Payment Options

_____ Check (made payable to NBDA)

_____ Credit Card      ___MasterCard   ___Visa     ___American Express

Card Number _____________________________________________________

Expiration date (required)______________

Signature____________________________________________________________

National Bicycle Dealers Association
3176 Pullman St. #117
Costa Mesa, CA 92626
Phone: 949-722-6909, Fax: 714-824-6281; e-mail: info@nbda.com