Membership Signup Form

Check one

_____New Membership

_____Renewing

Make check payable to the Decatur Bicycle Club, Inc.
Send application and check to:
Dave Carpenter, Treasurer
717 Crestline
Decatur, Illinois 62526

Membership Application

_____ Individual $10.00

_____ Family $15.00

Signatures of All Applicants Involved

Name

Date

__________________________ ________

Name__________________________________

Address _______________________________

City___________________________________

State & Zip_____________________________

Phone(__________)______________________

Email Address___________________________

Disclaimer: In signing this form, I understand and agree to absolve the Decatur Bicycle Club, Inc., it's members, and it's officers of all blame for any injury, misadventure, harm, loss, or inconvenience suffered as a result of taking part in any activity sponsored or advertised by said organization.