Required data is marked by an asterisk *. Information will be published in a club directory. PLEASE DO NOT provide phone numbers if you do not want them published. You may also opt out of having your email address published (although we may need you to supply it so we can send you the newsletter).
*NAME ____________________________________________ PHONE (H) ____________________________
*ADDRESS ____________________________________________ (W) ____________________________
*CITY ______________________________ *STATE ____ *ZIP ______________
*E-MAIL ____________________________________________
□ Do not publish my email address in the directory.
□ New Member
□ Renewal
□ Race Division ($3 Fee)
□ I agree to receive the newsletter by E-mail only
Interest Group: Touring, Recreational Riding, Race Division
Circle the option you desire. Mail this application with a check / money order made out to:
Spring City Cycling Club / P.O. Box 2231 / Huntsville, AL 35804.
| Membership Type | January-December | July-December |
|---|---|---|
Individual – email newsletter |
$12.00 |
$6.50 |
Individual – USPS newsletter |
$17.00 |
$9.00 |
Race Division – email newsletter |
$15.00 |
|
Race Division – USPS newsletter |
$20.00 |
|
Family – email newsletter |
$15.00 |
$8.00 |
Family – USPS newsletter |
$20.00 |
$10.50 |
Enter TOTAL (Check Payable to SCCC): ______
Release of Responsibility: The person signing this document certifies that he/she has examined the information on this release form and membership application and that all information is complete, true, and correct. For the sole consideration of being allowed to participate in Spring City Cycling Club (SCCC) activities, the undersigned hereby releases and forever discharges SCCC members, agents, officers, volunteers, personal representatives, their heirs, successors and all other persons, firms, and corporations liable or who might have claimed to be liable (all and each "Released Person") from any and all claims, demands, damages, actions, causes of action or suits of any kind and nature whatsoever, and particularly on account of all future injuries both to the person and property which may have resulted, or may in the future, develop from participation in or traveling to and from SCCC activities or SCCC sponsored events. I fully realize, acknowledge, and assume the risks of the hazardous nature and dangers of participating in any club activities, including by way of example and not limitation, the following: collisions with pedestrians, vehicles, other riders, and fixed or moving objects; safety hazards, equipment failure, inadequate safety equipment, and weather conditions; and the possibility of serious physical injury associated with cycling (each and all of which shall be referred to as 'Injury'). This release has been completely read by or to the undersigned and the terms hereof are fully understood and voluntarily accepted for the purpose of releasing each Released Person from any and all claims, disputed or otherwise on account of any injury.
Participant's Signature: ______________________________________________ Date:_________________
(Signature of Parent or Guardian, if under 19) ____________________________________________