-----------To
apply for WCBC annual membership-----------
Fill
in the form (include all names if household
membership), print it out and mail to the address above along with a check
payable to WCBC
If
your renewal month is:
Then
your renewal rate is:
Jan-Feb 2013
$25 family
$20 individual
$10 junior
Mar-Aug 2013
$20
family
$15 individual
$5 junior
Sept-Dec 2013
$15
family
$10 individual
$0 junior
New membership
Renewal
membership
NAME:
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE: Home-
PHONE: Alternate
Number -
E-MAIL:
By signing this waiver, I do hereby release and hold harmless and covenant
not to sue White Clay Bicycle Club, its officers, ride leaders,
administrators, insurance carriers, directors, members or volunteers, owners
and lessors of premises on which any activity takes place from all liability,
claims, demands, losses or damages that may result from an accident, injury,
or inconvenience on this ride. <strong>I further understand if I am not
a member, Insurance coverage is not extended to me by the Club and agree to
the terms of this agreement. </strong>I acknowledge that this activity
will be conducted over public roads or trails and facilities open to the
public and hazards are to be expected. I further agree that I will ride in a
safe, prudent and courteous manner, stop for all traffic signals, ride as far
to the right edge of the roadway as is safe, and obey all traffic laws. I
also agree to wear a protective helmet while participating on this ride and
to refrain from wearing one earplug, a pair of earplugs, or headsets for
entertainment. I fully understand that bicycling activities involve risks and
dangers of serious bodily injury, including permanent disability, paralysis
and death, and voluntarily participate in this activity. I agree that if at
any time I believe conditions to be unsafe, I will immediately discontinue
further participation. It is further understood and agreed that this waiver,
release, and assumption of risk is to be binding on my heirs and assigns. I
further attest that I am age 18 or older. (Note; If under age 18, parental
permission must be given before beginning this ride)
Signature:
Would
you like to volunteer and the club? (Select as many as apply): lead rides helping
with WCBC cycling events serve
on the Executive Committee
I am interested in the following: road/touring
tandem group race
teammountain
biking Exercise/fitness
bike
safety/education bicycle
advocacy