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CHESAPEAKE WHEELMEN, INC
P.O. Box 9372
Baltimore, MD 21228
OFFICIAL 2001 MEMBERSHIP APPLICATION
Please Print. Fill out as completely as possible and mail to the
above address. Make checks payable to: Chesapeake Wheelmen, Inc.
All memberships expire on January 1, 2002.
Name__________________________________________________________________________
Street__________________________________________________________________________
City______________________State______Zip Code___________Phone (___)
____________
Date Of Birth_________________________
E-Mail Address
_________________________________________________________________
New ( ) Renewal ( ) If renewal, what year did you first join?____________
Your Occupation (if student, what is your major?)_______________________________
Do you hold a USCF License? ( ) Yes ( )No
If Yes, USCF License #_________________________________What
Category?___________
Do you intend to apply for Chesapeake Wheelmen Racing Team Membership? (
)Yes ( ) No
Do you want your copy of The Newsletter via e-mail rather than U.S. Mail?
______
In submitting this Application for Membership I do hereby
for myself, my heirs, executors and administrators waive, release
and forever discharge any and all rights and claims, for or to be, for injury and/or
liability for which I may have or which may hereafter accrue to me against the Chesapeake
Wheelmen, Inc. bicycle club, its officers, agents, representatives, successors, and/or
affiliates, arising out of my participation in any, and all, activities sponsored by said
organization.
Applicant's Signature _____________________________________________Date_________
Consent and signature of parent or legal guardian if
applicant is less than eighteen (18) years old _______________________________
Annual Membership Fees |
Check | Cash | Rec'd by | |
Juniors (under 18) | FREE! | |||
Adults | $25.00 | |||
Grand Master (over 55) | $15.00 | |||
Family | $40.00 | |||
Optional Donation |
In order for the Chesapeake Wheelmen to continue to serve it's members
and grow as an organization, there is much work to be done. The club asks that all members
contribute a little of their time and talents to make our organization flourish. What
follows is a list of some of the positions that need to be filled.
You will notice that some tasks like committee membership or the Newsletter are year-round responsibilities while others like race registration or the club
banquet happen just a few times a year. All these jobs are important, but require very different commitments of time and energy. Please indicate on the
following list those positions in which you feel you are best able to help the club.
Please number your choices in order of preference.
Club Officer: |
Committee Membership: |
Rider Support _____Training Ride Leader _____New Rider Instruction _____Member Developmen _____Member Recruitment _____Roster Maintenance Sponsor Relations _____Sponsor Liaison Club Activity Coordination _____Organize Banquet _____Fund Raising |