McHenry County Bicycle Club

Box 917
Crystal Lake, IL 60039-0917

MEMBERSHIP APPLICATION

Print and mail this application with a check or money order made payable to:   McHenry County Bicycle Club
Membership:   New___________      Renewal____________      $15.00 Individual or family
Name:                                                                                                                                                                                                                     
Address:                                                                                                                                                                                                                 
City:                                                                        State:                                                                       Zip:                                                        
Home Phone:                                                                                         Work Phone:                                                                                           
e-mail:                                                                                                                                                                                                                    

Please indicate the type of cycling that interests you.  This will help the Board in planning rides:
_______Recreational                              _______Fast paced                                 _______EZ/Trail Rides    

Please indicate other activities in which you are interested:
_______Hiking                                       _______Camping                                     _______X-C skiing

Other:                                                                                                                                                                                                                     

The pace (mph) I prefer to ride is:                                                         The distance (miles) I prefer to ride is:
______8-12     ______12-16  ______>16                                              ______10-20  ______20-30  ______30-50  ______50-75  ______>75

The McHenry County Bicycle Club is run by an elected volunteer Board of Directors by and for its membership.
MCBC needs volunteers to help make its programs a success.  Please indicate your willingness to help in any of the following areas:

___I can lead a ride (preferred month):  ____Any_____Mar_____Apr _____May _____June _____July _____Aug _____Sept _____Oct
___I can help at the Udder Century Ride:  _______Registration      _______Rest stop
___I am interested in serving on the Udder Century Committee
___I am interested in serving on the MCBC Board
___I am interested in serving on the following Committees:
      _____Publicity      _____Newsletter      _____Safety/Education      _____Social      ____________________________Other

PLEASE READ AND SIGN BELOW
FAILURE TO SIGN WILL RESULT IN THIS APPLICATION BEING RETURNED TO YOU
STATEMENT AND RELEASE

As a member or participant in the McHenry County Bicycle Club, I hereby waive, release, and discharge any and all claims for damages, at law or equity, including, but not limited to, claims for death, personal injury or property damage which I may have, or which may have hereafter accrued to me, as a direct or indirect result of my participation in the McHenry County Bicycle Club and its events.  This release is intended to discharge, in advance, McHenry County Bicycle Club, Inc., its successors and assigns, the promoters, the sponsors, the officials and any involved municipalities or other public entities (and their respective agents, officers, directors, employees, members, successors and assigns) from and against any liabilities arising out of or connected in any way with my participation in any and all McHenry County Bicycle Club activities and events, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.

I further understand that serious accidents occasionally occur during bicycle events and that participants in bicycling events occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof.  Knowing the risks of participating in bicycling events, I hereby agree to assume those risks and to release, indemnify and hold harmless all of the persons or entities mentioned above who might otherwise be liable to me for damages.  It is further understood and agreed that this waiver, release and assumption of risk is binding on my heirs and assigns.  I also understand that helmets are required and following the Rules Of The Road is expected.

________________________________________________________________                            _____________________________

Signature(s) of Participant(s) (or Parent or Legal Guardian of a minor Participant)                                                             Date

Last update 01/25/09 pg