Membership Application Form

 

Cycling Interests:

Road [    ]

Dirt [    ]

Commuting[    ]

Fun [    ]

Social Activities [    ]

Member Name

Email 

 

Street

City, State, Zip

Home Phone Work Phone

Signature     Date

Print Minor Name  

Date of Birth

Print Parent/Guardian Name

Parent/Guardian Signature

Date 

Applications without proper signatures will be returned. All adult members must sign. All minors must have an adult sign for them.

In signing this release for myself or a member of my family who is under the age of 18, I acknowledge that I understand the intent hereof, and I hereby agree to and will absolve and hold harmless Bicycle Daze Cycling Club (BDCC), and their officers, and members and any other parties connected with Club-sponsored rides in any way whatsoever, singly and collectively, from and against any blame or liability for any injury, misadventure, harm, loss, inconvenience or damage suffered or sustained as a result of participation in said Club-sponsored rides or activities associated herewith. I also hereby consent to and permit emergency medical treatment in the event of injury or illness. I shall abide by traffic laws and regulations and practice courtesy and safety in cycling. I also understand that the BDCC strongly recommends use of helmets as an important element for safe cycling and that if I do not wear a helmet, it is in contradiction to the advice of the Club.