First name:

Last Name:

Street:

City:

State:

Zip code:

email address:

Phone Number:

We need you to fill out the following important assessment to help us assign you to the most appropriate learning group.
It is NOT to your advantage to overstate your abilities. This may result in us placing you into a group that is not appropriate for you.

Are there specific issues or concerns that you wish the Academy to address?

Are you currently a member of Almaden Cycle Touring Club?
Yes No

* If you answered "no" go to ACTC's Membership page and follow the directions on how to become an ACTC member.

When your Academy application, tuition, and proof of membership are received by the Registrar, you will be sent confirmation and instructions about where and when we meet.

If you have any questions contact Karin Crosby, Academy Dean of Registration at karinwc@aol.com.