634 S. Spring Street
Suite 821
Los Angeles, CA 90014
Tel 213.629.2142
Fax 213.629.2259
www.labikecoalition.org
LACBC BUSINESS PARTNER PROGRAM
ENROLLMENT FORM
CONTACT INFORMATION: 
Business Name: _____________________________________________________________

Contact Name: ______________________________________________________________

Address: ___________________________________________________________________

               ___________________________________________________________________

City: ________________________________________ State: ____ Zip: _________________

Phone: ___________________ E-Mail: ___________________________________________

Web URL: __________________________________________________________________
BUSINESS PARTNER PACKAGE
____ Steel Partner $250
____ Aluminum Partner $500
____ Scandium Partner$1,000
____ Magnesium Partner$2,500
____ Titanium Partner$5,000
____ Carbon Partner$10,000
PAYMENT INFORMATION 
Amount: $_____________________

___ Check    ___ American Express
		
___ Visa  ___ Mastercard  ___ Discover
		
Number: ___________________________
		
Exp Date: _____________

	
Signature: _________________________
MAIL FORM WITH PAYMENT TO:
Los Angeles County Bicycle Coalition
634 S. Spring St, Suite 821
Los Angeles, CA 90014

  Your donation to the Los Angeles County Bicycle Coalition is tax deductible to the extent permitted by law. Our tax ID# is 95-4845170.