Name_______________________________________________ [ ] New Member  [ ] Renewing

Address_________________________________________________________________________
                                             Home               Work
City_________________ State_____ Zip________ Phone ____________ Phone___________

E-Mail Address__________________________________________________________________

Note:  Dues are $15.00 per year, for either single or family membership.

I am interested in: (please check all that apply)
Ride types:               Miles per trip            Average speed (mph)
[ ] Day rides             [ ]  5 to 10              [ ] 10 to 12
[ ] Touring               [ ] 10 to 20              [ ] 12 to 14
[ ] Commuting             [ ] 20 to 30              [ ] 14 to 16
[ ] Tandem riding         [ ] 30 to 40              [ ] 16 to 18
[ ] Mountain bike rides   [ ] 50 to 100             [ ] 18 to 20
[ ] Overnight rides       [ ] 100+                  [ ] 20+

I am interested in assisting with: (please check all that may apply)
[ ] Leading day rides     [ ] Educational programs  [ ] Newsletter mailing
[ ] Leading night rides   [ ] Newsletter articles   [ ] Social events
[ ] Driving SAG wagon     [ ] Newsletter artwork    [ ] Group cooking
[ ] Slide presentations   [ ] Newsletter layout     [ ] Club officer


Occupation______________________________________________________________________

Interests_______________________________________________________________________

Suggestions_____________________________________________________________________


WAIVER:  In consideration of your allowing me to participate in North Carolina Bicycle Club rides
and events, I, intending to be legally bound, release and discharge any and all claims for damages,
death, personal injury or property damage, which I may have, or which may hereafter accrue to me, as
a result in my participation in Club rides and events.  This waiver/release is intended to discharge
in advance the North Carolina Bicycle Club, Inc., its officers, ride leaders, and members from and
against any and all liability arising out of or connected in any way with my participation in Club
rides and events, even though that liability may arise out of negligence or carelessness on the part
of the North Carolina Bicycle Club, Inc., its officers, ride leaders, and/or members.

I further understand that serious accidents occasionally do occur on bicycle rides and that
participants occasionally sustain mortal or serious personal injuries, and/or property damage, as a
consequence.  Knowing the risks, nevertheless, I hereby agree to assume those risks and to release
and hold harmless the North Carolina Bicycle Club, Inc., its officers, ride leaders, and members who
(through negligence or carelessness) might otherwise be liable to me for damages or injuries.  It is
further understood and agreed that this waiver, release and assumption of risk is binding on my
estate, my heirs, and assigns.


Signature____________________________________________________ Date______________

Signature of Parent or Guardian_________________________________________________
(if applicant is under 18 years of age)

Please send completed application and check for $15.00 made payable to NCBC to: