2008 CHINOOK CYCLING CLUB MEMBERSHIP APPLICATION
(Printable
PDF version)
(Calendar year membership period)
Name(s): _______________________________________________________________
Address: _______________________________________________________________
City, St., Zip: _______________________________________________________
E-mail: ________________________________ Phone: ______________________
Do NOT include e-mail
address on Club website ______
Do NOT include phone number on
Club Website ______
Interest(s): - MTB - Road - Racing - Touring - Other________________________
Membership Options: (check only one)
______ BASIC MEMBERSHIP - $15.00 (For the general Chinook Club Membership)
______ FAMILY MEMBERSHIP - $20.00
______ USCF/NORBA MEMBER - $25.00 (You intend to race USCF/NORBA and wear
the Chinook Club jersey)
______ USCF/NORBA FAMILY - $30.00 (You and one or more family members intend
to race USCF/NORBA...)
Note: Chinook Club membership fee does not include USCF or NORBA membership fees.
Waiver and Release: In consideration of the acceptance of my application
for membership in Chinook Cycling Club, I hereby waive, release and discharge all
claims for death, personal injury, or property damages which I may have or which
may hereafter accrue to me as result of my participation in club activities.
I realize that there are certain dangers inherent in the sport of cycling, and I
assume the risk of injuries that may result from those dangers, including mortal
and or serious bodily injury. This release is intended to discharge the Chinook
Cycling Club, the USCF/NORBA, the Club's sponsors and agents from and against any
and all liability arising out of or connected in any way with my membership in the
Club, even though that liability may arise out of the negligence or carelessness
on the part of persons or entities mentioned above. This waiver and release
shall be binding on my heirs and assigns. I also hereby agree to wear an ANSI
and or SNELL approved helmet when participating in any club cycling activity to
include, but not limited to club rides, races and tours.
Signature: ___________________________________ Date:_____________________
Form prints onto an 8.5" x 11" sheet of paper. Make checks payable to Chinook Cycling
Club and mail to:
Chinook Cycling Club,Inc.
2120 Hamilton Ave
Richland, WA 99354
Chinook Logos Designed By - Kurt Recknagle
Web Site Design - Tony Sako