MID-YEAR 2000 MEMBERSHIP FORM
1658 N. Milwaukee Ave. #171, Chicago, IL 60647
Hot Line (312) 458-9841
Website: WCCC.IsCool.net

To become a member of WCCC, please print out the form below, fill out,  and mail to the above address.  Or, if you prefer, you can open and print the the PDF version of this document.
Thank you.

(PLEASE PRINT)  First Name: _______________________________ Last Name:____________________________________

Street Address: ___________________________________________________________________________________________

City, State, Zip Code: _____________________________________________________________________________________

Phone(s): _________________________________________ E-Mail* ______________________________________________
*very important if you want to receive up-to-the-minute updates on WCCC events and to reduce our communication expenses

Individual $15 Dues for mid-year membership (August 2000 through March 2001) - Paid By: q Check q Cash   Rec'd:________

PRIVACY. The information above is to be used internally by WCCC only; however it may be made public with your permission:
q  My name, address, phone, e-mail, and photos taken at WCCC activities of me may be published without restriction.
q  Please do NOT use my personal information in WCCC printed publications, or on the internet, without my written permission.

Check as many boxes as apply to you:
I would like to help with:      q Outreach           q Newsletter      q Club management
I would like to lead:           q Rides               q Social
I have and wish to share:    q Big house / yard q Party room

Windy City Cycling Club Waiver of Liability

WAIVER OF NEGLIGENCE AND COMPLETE RELEASE OF LIABILITY

I wish to participate in noncompetitive bicycle rides sponsored by the Windy City Cycling Club. I understand that in participating in these rides I will be using public streets and facilities where many hazards exist, and I am aware of and appreciate the risks which may result. I also am aware that accidents may occur during bicycle riding and that I may be seriously injured or killed as a result. I am voluntarily participating in this ride with knowledge of the dangers involved, and I agree to accept any and all risks of injury or death.

In consideration for being permitted by Windy City Cycling Club to participate in its rides, I agree to assume all risks and to release and hold harmless Windy City Cycling Club as well as its directors, officers, agents, employees, and members, who, through negligence or carelessness, might otherwise be liable to me. I intend by this Waiver and Release to release, in advance, and to waive my rights and to discharge Windy City Cycling Club and all the other persons mentioned above, from any and all claims for damages for death, personal injury or property damage which I may have, or which may hereafter accrue to me, as a result of my participation in their rides, even though that liability may arise from negligence or carelessness on the part of the persons or entity mentioned above. I understand and agree that this Waiver and Release is binding on my heirs, assigns and legal representatives.

I am physically capable of completing this ride. If I am aware of or under treatment for any physical infirmity, ailment or illness, my medical care provider knows of and has approved my participation in this ride. I agree to accept and abide by all instructions of the ride leader. I have carefully read this Waiver and Release and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Windy City Cycling Club and sign it of my own free will.

Parental signature is required if the rider is under 18 years of age.

Signature of Member:             _____________________________________

PRINT Emergency Contact:  _____________________________________  Relationship: _____________________________________
 

Emergency Phone(s):             ________________________________________