Membership Application

    

Please mail this application with check payable to Blackhawk Bicycle and Ski Club to:

Blackhawk Bicycle and Ski Club
PO Box 6443
Rockford IL 61125-1443

Name _______________________________________________________  Age______ Address___________________________________________________________________ City ________________ State___________ Zip____________ Phone_________________ Family Names_____________________________________________________________ E-Mail Address ____________________________________________________________
DUES: Individual $15, Family $20,  New__  Renewal__  $ Enclosed _______   SPOKES SIGNALS newsletter delivery (circle choice ):  Email  or  USPS-Mail   INTERESTS (circle choices): Touring,  Racing,  Tandem,  Mountain Biking, Cross Country Skiing   WHAT COMMITTEE WOULD YOU BE WILLING TO HELP ON? (circle choices):
Invitational Ride Road Clean-Up	Banquet Advocacy	Picnic Racing	Touring Other:  _ _ _ _ _ _ _ _ _ _ _ _ _

 

 

The Blackhawk Bicycle and Ski Club, its members and officers assume no responsibility for personal injury, damage to equipment, theft or other loss taking place on any club ride or other activity. A responsible adult must accompany riders under 16 years of age. In submitting this application, the applicant agrees to the above liability release and limitations and holds the Club, its officers and members harmless.

        

Date: _ _ _ _ _ _ _ _ _     Signature(s) of all BBSC members in your family: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _