Choose a Membership Type (cost is for one year and includes GST)

(unlimited family members or max. 3 unrelated people, at one residential address) 
 $139
 
 $99
(pensioner, unwaged, full time student - proof required) 
Concession Type
Conc. Card Details
Conc. Number
Conc. Expiry Date (dd/mm/yyyy)
 $79

Enter Your Name

*(all members listed must include first name, last name and date of birth)
First Name
Last Name
Date of Birth
(dd/mm/yyyy)
Gender

Phone Number(s)

* (please enter at least one)
Telephone (H)
(W)
(M)

Enter and Confirm your Email Address

Email Address * Confirm Email Address *

Choose a Password (Less than 10 characters long, including only A-Z or 0-9)

Password * Confirm Password *

Postal Address

Address 1 *
Address 2
Suburb/City *
State *
Postcode *
Country

Residential Address (if different from above)

Same as Postal Address
Address 1
Address 2
Suburb/City
State
Postcode
Country

Billing Address (if different from above)

Same as Postal Address
Address 1
Address 2
Suburb/City
State
Postcode
Country

Donate to Bicycle Queensland

I wish to donate the following to contribute to the campaigns.

Why are you joining Bicycle Queensland? *

Promo Code

Promo Code (enter if you have one)