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 _______

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: ____________________________

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Last Revised: 11 March 2008 Send website comments and suggestions to Webmaster