Name:
Birthdate:
Address:   
City:
State:
ZIP:
Phone:   
Email:
Check One: Male                  Female
Check one: New Member   Renewal
Check one: Runner              Walker
Membership 1 year 2 year 3 year
Adult $20 $38 $54
Family $25 $48 $69
Sponsor $35 $68 $99
Student $10
Family Membership are limited to immediate family members at the same address including children 18 years old and under. Please list names and ages:
Are you interested in volunteering for the CBRC?  yes   no
CBRC Races Newsletter Membership Computer Other
Fill out this form, print it, and send it with your check or money order to:

CBRC - Membership
315 East George Washington Blvd.
Davenport IA 52803


We try to keep our dues low and therefore do not want to pay for online credit card service. We apologize for the inconvience of having to mail a check.