New Renewal
Cycling interests: Racing Mountain Road
Easy Riders (slower touring)
Name: ______________________________________________________
Address: ______________________________________ Apt:
________
City:
Home Phone:(___)____-______ Bus. Phone:(___)____-______
Birthday: ___ /___ /___ Occupation: ___________________
E-mail address: ___________________________
Affiliated Memberships: LAB (LAW) USCF (cat:
___) NORBA (cat:
___)
Other(s)____________________________________________
Please check here if you do *NOT* want to be
included in the
published
directory of FLCC members.
Membership class and fee
Individual -
$10.00 per year ($3.00 after September 1)
Family - $12.00
per year for two or more family members
Associate -
$7.00 per year for members of other cycling clubs who want to participate in
FLCC activities
In order to maintain a program of cycling events, the Finger
Lakes Cycling Club needs the help of all its members. Please indicate below any
duties you could help with.
Leader of a
tour Course
marshal Finish
judge Publicity
Qualifications, restrictions, and instructions
- Membership is restricted to those who are 12 years of age
or older.
- Applicant must sign waiver below. Those who are under 18 years of age must
have a parent or legal guardian co-sign.
- Members must wear helmets while participating in club activities.
- Make checks payable to "Finger Lakes Cycling Club"
- Mail completed and signed forms with check to: Tania Schusler,
Waiver of rights
In consideration of my being accepted as a member of the
Finger Lakes Cycling Club, I do hereby waive for myself, my heirs, executors,
administrators and assigns all claims and rights for damages I might have
against the Finger Lakes Cycling Club, its agents, representatives and assigns
for any and all injuries suffered by me, including death, or for damage to
bicycle or to other personal property, while participating in any races, tours
or other activities organized by the aforementioned club. This also pertains to
travel to and from the starting point of all such activates. I further certify
that I have no physical defects or weaknesses that might make participation in
these activates harmful to me.
Applicant's signature: __________________________ Date:
________
Parent or guardian: ____________________________