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 |
|
|
What Is Your Interest in Triathlons? |
| Individual | $10.00 | Age | Not Interested | |
| Family | $10.00 | I Would Like to Try It | ||
| 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 |
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