MEMBERSHIP APPLICATION - ARIZONA BICYCLE CLUB
(Fill out, sign your name, print and send via U.S. mail 
we cannot accept funds or release signatures electronically) :(

Members will receive the ABC Chain Letter from ABC each month.
No refunds on membership.
Please mark the type of membership you are applying for:
(US funds)Make checks payable to 'Arizona Bicycle Club'.

Individual: 1 year $25.00, 2 year $45.00
Family: 1 year $35.00, 2 year $65.00
Senior (55+): 1 year $20.00, 2 year $35.00
Senior (55+) Family: 1 year $25.00, 2 year $45.00

Name (last, first):

Address:

City:

State:

Zip+4:

Phone:

Email:

Where did you hear about ABC?

RELEASE AND WAIVER:
I hereby waive and discharge all claims, actions and causes of
actions by me, my heirs, executors and administrators against
the Arizona Bicycle Club (ABC) and its officers, directors,
chapters, sponsors and sponsoring municipalities, organizations
and any others connected with any ABC event, for any injury,
harm or death, damages, loss or inconvenience sustained as a
result of my participation in any ABC event, or any activities
associated therewith. I am aware of the inherent risks in
participating in a bicycling event, and I assume all
responsibility for my own safety. I understand that ABC requires
bicycle helmets to be worn by all participants in all ABC events
while operating bicycles and that there is no exception to this
requirement. I agree to wear a bicycle helmet at all times
during ABC bicycle events when I am riding a bicycle. I agree
to obey all traffic laws at all times during any ABC event.
I also consent to and permit emergency medical treatment in
the event of injury or illness. I also give full permission
for the use of my name and photograph in connection with an
ABC event.


SIGNATURE or Signature of Parent/guardian for minor


________________________________

Amount enclosed: $
Today's date
Make checks payable to 'Arizona Bicycle Club'.

Send form and check to:
Arizona Bicycle Club
Attn: Membership
P.O. Box 7191
Phoenix, AZ 85011-7191

Your address label shows the date when your membership expires.

Updated 11 November 2002