TYLER BICYCLE CLUB
Membership Application

1.  I acknowledge, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified to participate in such activity.  I further acknowledge that the Activity will be conducted over public roads and other public facilities where the hazards of traveling are to be expected.  I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2.  I hereby make known to whomever it may concern that I hold the Tyler Bicycle Club, its Officers, Members and Ride Leaders blameless in case of accident, injury, or misadventure of any kind.  I recognize my personal responsibility and will do my part to develop and follow safe cycling habits whether riding alone or in a group.
Print Adult Name Signature Date: DOB:
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List Family Members:
Name: DOB: Name: DOB:
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Address Email Address
City State Zip Telephone
Circle types of riding:   Road     Mountain     Recreational     Tours     Racer     Duathlon     Triathlon
Annual Dues:
     Jan 1st to Dec 31st--$20.00
     July 1st to Dec 31st--$10.00
Renewal Date:  Jan 1st		 Mail Checks to:
     Tyler Bicycle Club
     P.O. Box 6734
     Tyler, TX 75711
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