Columbia Cycling Club Application

Name of Primary Member                                                                    

Check If:

         New Member
If Family Membership,
Name of Spouse		                                                                            Renewal
Home Address                                                                   
City/State/Zip                                                                   
Home Phone                                                         Work Phone                                              
Home Email                                                        Work Email                                              

 
Check One:

 
What Is Your Interest in Triathlons?
Individual $10.00          Age                           Not Interested
Family $12.00                      I Would Like to Try It
Out of Area $20.00 ____             I Actively Participate in Triathlons
(Reside outside of Maury, Marshall, Hickman, Lewis, Lawrence, Giles, and Williamson Counties)    
 
In consideration of the Columbia Cycling Club (a.k.a. Columbia Bicycling Club) granting me permission to ride in their events, I hereby waive all claims for damage or loss to my person and/or property which may be caused by an act or failure to act, of the Columbia Cycling Club, its officers or agents. I assume the risks of all dangerous conditions on and about the route to be traveled and waive any and all specific notice of the existence of such conditions. I agree to wear an ANSI or Snell approved helmet on all club rides.
 
Primary member's signature                                                                                         

(youth members must have signature of parent) 
If Family membership, spouse's signature                                                       , Date                                         
 
Make check payable to Columbia Cycling Club and mail to:
 
Attn: Membership
Columbia Cycling Club
1116 West 7th St., PMB 127
Columbia, TN  38401
   For Columbia Cycling Club shirts:
   Contact Duane Leach
   (931) 388-0135
 
Please volunteer for a committee. Committee members will meet on an infrequent basis for lunch or breakfast in a Columbia area restaurant.
 
CHECK AS MANY AS YOU ARE WILLING:
            Cyclo-cross Race Committee (a January race)
            Mountain Bike Race Committee (a March race)
            Century Tour Event Committee (an August event)
            Jailbreak Triathlon (an October Race)
            Mountain Bike Park Committee
            "B" Ride Committee (Establish and assign less competitively paced rides)
            Web Page Committee (meet once or twice per year to discuss overall Web design and domain)
            Public Relations Committee (Should we be lobbying for shoulders on roads, prevention of chip and tar on Natchez Trace, etc.?  Should we be putting more items in the paper?)
            Christmas Party Committee