Application for Membership
Please
read this carefully and sign up to join!
I,
for myself and for any minor on whose behalf I sign this membership
application, agree that:
1)
Bicycling is a potentially hazardous activity and that
accidents can occur from negligence or carelessness;
2)
Ride leaders' maps and/or written directions are provided
for my convenience only and not to guarantee a safe route or trip; and
3)
I voluntarily participate in club events and assume all risks associated with participation therein, including but not limited to injury, falls, contact with other participants, weather, traffic and road
conditions; all such risks being known and appreciated by me.
|
Name: |
|
|
Address: |
|
|
City/State/Zip: |
|
|
Primary Phone: / |
Secondary Phone: / |
|
E-Mail: |
|
|
Signature:
(Signature of parent or guardian if applicant is under 18) |
|
|
Emergency Contact: |
Emergency
Phone: / |
|
I obtained this membership application from: |
|
|
As well as online format, I want to receive a paper copy of the newsletter: Yes q No q |
||||
|
Do not share my contact information: |
|
Address |
Phone |
E-Mail |
|
Within the Chicago Cycling Club |
q |
q |
q |
|
|
With other bike-related organizations |
q |
q |
q |
|
|
I would like to help with: |
Leading A Ride q |
Meetings
q |
Social
q |
Newsletter q |
|
Publicity
q |
Invitational
Ride q |
Events
q |
|
|
Annual dues: |
Individual $20.00 q |
Household $25.00
q |
New:
q |
| (Multiple individuals at one mailing address.) |
Renewal:
q |
Make
checks payable to Chicago Cycling Club and mail to:
Chicago
Cycling Club, P.O. Box 1178,Chicago, IL 60690-1178