BATON ROUGE BICYCLE CLUB MEMBERSHIP APPLICATION
Annual membership dues are $5 per individual and $10 for couples and families. These fees allow each individual to hold membership status in the BRBC. This gives each member voting privileges at official meetings, eligibility for board membership, and participation in club rides and parties. Dues are valid for one year. Bring completed form with your dues to any Baton Rouge Bike Club event, or send to: Baton Rouge Bicycle Club, P. O. Box 253, Baton Rouge, LA 70821-0253
|
Membership Status New?____ Renewal?____ Primary Member___________________________________ Other Members__________________________________ Street/PO/Apt______________________________ City_____________ St_______ Zip________ Phone H:(____)_______W:(____)__________ Email_____________________________________ |
MEMBER INTEREST SURVEY I am interested in the following club activities:
__ Leading rides __ Century ride help (routes, reg., food, SAG) __ Advocacy/Legislation/Safety __ Social Events (Parties, Dinner Rides, etc.) __ Leadership (Board Membership) __ Training Assistant (Youth and adult classes) __ Bicycle Maintenance __ Club Jersey __ Other ___________________________ |
|
RELEASE OF RESPONSIBILITY I hereby hold harmless and release from liability from any claim, cause of action, or damages whatsoever, the members and officers of the Baton Rouge Bicycle Club and League of American Bicyclists for any damages, injury or accident which may occur to me as a result of participation in any activity of the Baton Rouge Bicycle Club. Further, if I am the responsible parent or guardian of any child under the age of 18, I hereby agree to the above in my capacity as a parent or guardian of that child. Further, should that child be under the age of 15, I hereby agree to personally accompany and supervise my child at all club activities. Signature:_______________________ Date:_______ Signature:________________________ Date:______ Participant(s), or Parent(s) (Both parents must sign) or Guardian for participants under 18 |
|