ELMHURST BICYCLE CLUB MEMBERSHIP FORM

Please complete form, print, sign, and mail with your check to:
ELMHURST BICYCLE CLUB
P.O. BOX 902
ELMHURST, IL 60126

 Individual($20)    Family($25)             New Membership     Renewal

EBC's membership year runs from January 1 to December 31.

Name 
(If family membership, list names of all members)
Address 
City    State    Zip Code 
Phone: Home    Work 
Email 
NOTE: Indicate with ** next to any information you do not want to appear in club directory.


Membership includes access to monthly downloadable club newsletter in PDF format from the club website.
Newsletter delivery(check one):  ___ Download (faster, full color)    ___ Snail mail (slower, black and white)

The Following Is A Release And Waives Your Rights In the Event of Injury and/or Death. In consideration of being permitted to be a member of Elmhurst Bicycle Club and to participate In club rides and/or events, including transportation to and from same, I do hereby for myself, my heirs, executors and administrator release, waive and forever discharge Elmhurst Bicycle Club, its officers and members from any and all clause, demands, actions or liabilities on account of any injury to me which may occur from any cause whatsoever, including negligence or other fault on the art of anyone released hereunder, during my participation in or transportation to or from said rides and/or events. I ACKNOWLEDGE I AM AWARE OF THE RISKS AND HAZARDS INHERENT UPON ENGAGING IN SAID CLUB ACTIVITIES, AND I DO SO ENTIRELY UPON MY OWN INITIATIVE, RISK AND RESPONSIBILITY. I FURTHER UNDERSTAND THE CLUB DEPENDS ON ITS MEMBERS TO PROVIDE AND LEAD CLUB ACTIVITIES AND THAT THOSE MEMBERS RELY ON THE PROTECTION AFFORDED HEREUNDER. I hereby further agree to operate my bicycle in a manner that is safe to me and those around me, to observe all applicable safety regulations and to conduct myself in a manner that will be complimentary to the sport of bicycling. It is my intent that this release and waiver apply at all times, notwithstanding that my membership in the Elmhurst Bicycle Club may have expired, elapsed, been renewed or reinstated after a period of non-membership. I FURTHER ACKNOWLEDGE THAT I HAVE READ THE FOREGOING RELEASE AND WAIVER AND UNDERSTAND IT, INCLUDING THAT IT IS INTENDED TO COVER OCCURRENCES WHICH MAY NOT YET HAVE OCCURRED AND WHICH ARE UNKNOWN TO ME, AND NOTWITHSTANDING THE FOREGOING, I SIGN IT VOLUNTARILY WITH THE FULL INTENT THAT IT BE FOREVER ENFORCEABLE.

Signature(s) of all adult members

Date_________Signature_______________________________________________


Date_________Signature_______________________________________________