Name

Address

City State Zip Birthday

Phone: Home Work

E-mail Address

Other Family Members and ages

Is it ok to publish your information in the newsletter and club directory     Yes    No

Is it ok to publish your email address on the website                                  Yes    No

In consideration of my membership, I agree not to hold the Chattanooga Bicycle club nor any of its members or organizers liable for any injury or damage however caused, which may result from participation in any event sponsored by the Chattanooga Bicycle Club. I also agree to obey all applicable vehicle laws and principles of safe bicycling.

Signature ________________________________________ Date

Parent/Guardian if Under Age 18 _____________________________________________

Areas of Interest:
Road Bike ATB Trail Maint Day Rides Advocacy Touring Fitness Tandem

Miles per week you bicycle in season              New Member Renewal

VOLUNTEERS ARE THE LIFEBLOOD OF OUR ASSOCIATION. IT IS IMPORTANT FOR ALL MEMBERS TO DONATE A FEW HOURS EACH QUARTER TO ONE OR MORE OF THE ACTIVITIES LISTED BELOW.

Trail Maint  Member Activities  Leading Organized Rides  Festival/Century/Volunteer 

Make checks payable to Chattanooga Bicycle Club; Send application and check to CBC Member Coordinator, PO Box 11495, Chattanooga, TN 37401;