Flyers Cycling Club
2002 Membership Application Form

The Flyers Cycling Club is dedicated to having fun! Get involved ... this Club is for you.

Name: ____________________________________________
Address: __________________________________________
City: _____________________________________________
State / Zip: ________________________________________
Phone #: __________________________________________
Date of Birth: _________________________Age: __________
Email: __________________________________________

Membership Type

(  ) General Membership                       $15.00

(  ) USCF / NORBA Membership        $20.00

(  ) Family Membership                        $20.00

The Club fiscal year is January 1 to December 31 of the following year.
Make checks payable to:
Flyers Cycling Club
8220 W Gage Blvd PMB #727
Kennewick, WA 99336

I acknowledge that cycling is an inherently dangerous sport in which I participate at my own risk and that the Flyers Cycling Club, USCF, and NORBA are non-profit organizations formed to advance and promote the sport of cycling, the efforts which directly benefit me. In consideration and acceptance of my membership in the Flyers Cycling Club, I hereby release and discharge all claims for liability, death, personal injury, and/or property damages which I may have or which may hereafter accrue in me as the result of my participation in any Club activity. This release shall discharge the Flyers Cycling Club, the USCF, the NORBA, the Club's sponsors and agents from and against any and all liability that may arise out of the negligence or carelessness actions of the part of persons or entities mentioned above. I also hereby agree to wear an ANSI and/or Snell approved helmet when participating in any cycling related event including, but not limited to, Club events, tours, rides and races.

Signature: _________________________________________

Guardian if under 18 ________________________________