outdoor.gif (1323 bytes) River City Bicycle Club
        Application Form


Yes!  I want to join!  Print & mail application to:

Hauestein's
547 Main St.
Tell City, IN 47586

Make check payable to:

River City Bicycle Club

Name: _____________________________________________
Address: _____________________________________________
City: ___________________ State: ________
Zip: ___________________ Phone: ___________________

Release of Liability:

Members of the River Valley Bicycle Club freely elect to ride as a club and Participate in other club functions.  In signing this form for myself and/or my family members, I hereby Waive all claims for any loss, misadventure, injury, harm, or inconvenience suffered as a result of any club activity.   I agree to hold its agents and representatives harmless for all such losses.   I understand that I am responsible to abide by all traffic laws and regulations governing bicycles and take full responsibility for my actions.  I also assume the risks of all dangerous conditions while riding and waive specific notice of such conditions.

Signature: ______________________________________ Date: ________

(Head of Household for Family)

    

Participants 16 & 17 years old:

    
Signature: ______________________________________ Date: ________

(Participant)

  
Signature: ______________________________________ Date: ________

(Parent/Guardian)

 

Individual Membership:  $10.00
Family Membership:  $15.00