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P.O. Box 9372
Baltimore, MD 21228


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.

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:

Would you accept a nomination to be?

_____Vice President

Committee Chair:

Would you chair (lead) any of these committees?

_____Race Committee
_____Teams Committee
_____Nominating Committee
_____Masters Committee

Committee Membership:

Please indicate the Committee on which you wish to serve.)

_____Production Staff
_____Distribution Staff

Race Support
_____Road Marshall
_____Equipment storage and transport

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

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