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Please send check (no cash please) with application to:

Montgomery Bicycle Club
P.O. Box 231116
Montgomery, AL 36123

Note amount by membership type. Dues are payable on March 1 of each year and cover the period of March 1 – February 28. For members joining after August 1 the membership fee is $6.00 for a Single membership and $9.00 for a Family membership and will cover the period from joining until the next February 28.

Name_____________________________________Date__________________

Other family members (family membership only)________________________

Street Address___________________________________________________

City_____________________ST_______ZIP___________________________

Home Phone___________________________Work Phone_______________________

E-Mail Adress_______________________________________

New____Renewal____
Temporary (90 days) $5_______ Student ($8) _____Single ($12.00) ____Family ($18)____
Temporary rate is offered primarily for visitors to Montgomery who wish to participate in time trials.
The student rate applies to high school students and full-time college students only.
Ride Experience:
Beginner (5-10 miles)_____Intermediate 16-40 miles_____ Experienced (40+ miles)_____
Ride Interest(ck all that apply):
Leisure____Touring_____Racing_____Off Road____Tandem_____Other_________________
Are you a member of:
LAB______USCF______IMBA______NORBA______USAT______Other?___________________

WAIVER - READ BEFORE SIGNING

I understand that the Montgomery Bicycle Club, Inc. and its officers and members are not responsible for, and are not insurers of, my personal safety during club activities. Therefore, I, the undersigned, intending to be legally bound, hereby for myself, heirs, executors, and assigns, waive and release all rights and claim to damages I may have against the Montgomery Bicycle Club, Inc., their officers, representatives, successors and assigns, for all and any activities sponsored by the club by reason of their negligence in participating in or sponsoring or planning or arranging the event. I attest and verify that I am physically fit and will not participate in any event for which I am not adequately trained.

Signature_______________________________________________

Spouse (if family member)_________________________________

Guardian Signature (members under 19)______________________