Please print out the following application and mail along with a check for the appropriate amount to:

    Finger Lakes Cycling Club
    c/o Charles Hamilton
  950 Danby Road, Suite 300
  Ithaca, NY  14850

Electronic applications cannot be accepted because the waiver must be signed.

Finger Lakes Cycling Club Membership Application

 New      Renewal+
 
Cycling interests:     Touring       Racing        Mountain        Road
 
Name:______________________________________________________
 
Address:______________________________________ Apt:________
 
City:___________________________ State:_______ Zip:________
 
Home Phone:(___)____-______    Bus. Phone:(___)____-______
 
Birthday:___ /___ /___         Occupation:___________________
 
E-mail address: ___________________________
 
Affilated 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: Finger Lakes Cycling Club c/o Charles Hamilton, 950 Danby Road, Suite 300, Ithaca, NY  14850

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 activites. I further certify that I have no physical defects or weaknesses that might make participation in these activites harmful to me.

Applicant's signature:__________________________              Date:________
Parent or guardian:____________________________