Name ______________________________

Address ____________________________

City _____________ State ____ Zip _______

Phone (____)________________

eMail ________________________________

_____ I do not wish my name or e-mal address published.

Dues

_____ Individual / $10 year

_____ Family / $15 year

$_____ Additional

Please make checks payable to:
White River Cycle Club

RELEASE of
THE WHITE RIVER CYCLE CLUB,
OFFICERS, ORGANIZERS AND SPONSORS:

I hereby absolve and forever hold harmless all officers, members, organizers, spnsors, individuals and groups of the White River Cycle Club and all municipalities through which I ride from any liability or damages of any kind which any of the undersigned or their bicycles suffer as a result of participating in any of their events. I understand helmets are required for all sponsored events. I agree to obey all traffic laws and operate my bicycle safely. I certify thet I have read and understands this statement.

Signature _____________________________

Date _____________________