WESTERN PENNSYLVANIA WHEELMEN CLUB MEMBERSHIP APPLICATION

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

* = Required field

Membership type * New Renewal
NAME(s) *
Street Address *
City, State & ZIP *
E-MAIL ADDRESS *
TELEPHONE NUMBER
DATE //

To join the WPW Yahoo 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.)