WESTERN PENNSYLVANIA WHEELMEN CLUB MEMBERSHIP APPLICATION
New Member or Renewal (please circle one)


 The membership year is January 1 through December 31.  Persons under 18 can
be accepted in a family membership only.

FAMILY Annual Dues $19.00 -- FAMILY 3 Year Dues $54.00

INDIVIDUAL Annual Dues $17.00 -- INDIVIDUAL 3 Year Dues $48.00


  
  
NAME(s)   

Street Address     
City, State & ZIP  

TELEPHONE NUMBER   

DATE //  

E-MAIL ADDRESS  

 To join the WPW Topica Email group, go to the home page, click on Member Info, Email List, 

 and follow the instructions.

 Make your check or money order payable to: WPW Bicycle Club and 
  mail with this application to P.O. Box 99684, Pittsburgh, PA 15233.

  RELEASE
 In signing this release for myself and/or for the above named
person (if under 18), I understand the intent of this release and agree to absolve all officers,
members and associated entities be they individuals or organizations singly or collectively of
all blame for an injury, misadventure, harm, loss or inconvenience suffered as a result of
taking part in any activity associated with or related to the Western Pennsylvania Wheelmen. 
                                                                 October 1998
SIGNED______________________________________________________________________
SIGNED______________________________________________________________________
SIGNED______________________________________________________________________
SIGNED_____________________________________________________________________
(Each family member must sign.)

WPW is an all-volunteer club.  To function, we need assistance in many
areas.  Please check below any areas in which you or your family can
help:

  
Leading rides Newsletter  WorkshopsAdvocacy
Art/graphics  Ride layout  Other