3.00 $3.00 - Rapid Wheelmen

PO BOX 1008 • GRAND RAPIDS MICHIGAN 49501
WWW.RAPIDWHEELMEN.COM
PRESORTED STANDARD
US POSTAGE
PAID
GRAND RAPIDS, MI
PERMIT NO. 1233
5
Rapid Wheelmen Membership Application
Name ___________________________________________
Address _________________________________________
Membership year: April 1 - March 31. Join after November 1 and you’ll
be a paid-up member until March 31 of the following membership year.
City ________________________________ State _______
Zip __________Phone _____________________________
E-mail address _______________________________________
Family members ______________________________________
& birthdates_________________________ New address? Y N
Do not include my name in the printed membership list ________
Membership ___new ___renewal $20.00
Club jersey (at meeting) $60.00
Club jersey (by mail) Louis Garneau semi-relaxed fit $64.00
size (circle) S M L XL XXL
Donation
$_____
Total
$_____
Make check payable to and mail to:
What year did you first join? _____
Waiver and Hold Harmless Agreement
Rapid Wheelmen, Inc.
PO Box 1008
Grand Rapids, MI 49501
I acknowledge that bicycling is an inherently dangerous activity. I hereby agree to release, absolve and hold harmless Rapid Wheelmen,
Inc. and its officers and members, and any other parties connected with the organization from any blame or liability for any
injury, harm, loss, damage or death sustained as a result of participation in Rapid Wheelmen, Inc. activities. I shall abide by the rules
and regulations of the Rapid Wheelmen, Inc., and traffic laws and regulations, and I shall practice courtesy and safety in bicycling. By
continuing on to the ride schedule, i acknowledge that i understand the terms of this agreement as a legally binding waiver and hold
harmless agreement and agree not to sue rapid wheelmen, inc. or its directors, members and agents.
Signatures of all adult riders
Signature of parent or guardian (if applicant is under age 18)
date
date
Page 16 JULY
date
2005 RAPID WHEELMEN BICYCLE CLUB date