League of Illinois Bicyclists Membership Form

Please complete the information below then click the "Check" button at the bottom of the page.
1. About you Please note that LIB does not sell our address or e-mail lists. We only send e-mail when a local advocacy issue arises. ** denotes required information.	First name **
	Last name **
	Address **
	City **
	State **
	Zip **
	Telephone	(e.g., 312 555 1212)
	email address **
	Membership preferences:	I prefer to receive newsletters via US Mail.
		Do not share my name with other bicycle advocacy groups.
		Omit my name from the annual newsletter listing of contributors.
	Comments

2. Membership Level (Select one)	$25 Basic
	$35 Family
	$60 Advocate
	$80 Sustaining
	$100 Century
	$125 Patron
	$200 Benefactor
	$250 Bronze
	$500 Silver
	$1,000 Gold
	Other amount $

3. Optional Premiums	Membership Level	Premiums available for that level (Select one)
		No premium desired thank-you.
	Advocate ($60 or higher)	LIB T-shirt in selected size:
		Planet Bike Blinky 3 taillight #3099
		Planet Bike CO2 inflator #1021
		Planet Bike Mini-pump #1020
	Sustaining ($80 or higher)	Planet Bike Insight Beamer 1 light set
		Protégé 9.0 bike computer #8002
	Century ($100 or higher level)	Illinois "Pedal Power" Jersey size:

4. Payment **	Click the button below to submit your membership information and pay with a check.

Top of page
LIB home page

Revised 2008-11-28
Created 2008-11-19
Lee Pirtle,