To join the Lake Erie Wheelers, fill out and sign this form and mail it with your dues to the address shown. Also, please sign the release form at the bottom.

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2010 LAKE ERIE WHEELERS MEMBERSHIP APPLICATION FORM

Name: ____________________________________________ Age: _________

Address: ________________________________________________________

City: _____________________________ State: ______ ZIP: __________

Phone: (____)________________  E-mail: __________________________
(Please provide e-mail address for club updates & news.)

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LAKE ERIE WHEELERS MEMBERSHIP AGREEMENT AND RELEASE

I have read the following agreement and release and agree:

I acknowledge that participation in this activity involves risk of bodily injury. I understand the nature of the possible risks and willingly accept them under the conditions set in this release and waiver of liability.

I hereby release Lake Erie Wheelers, its officers, members, agents and sponsors, singly and collectively, from any and all liability for any and all injuries and property loss, including misadventure or inconvenience, occurring to myself, associated with Lake Erie Wheelers' rides, events and other activities.
I have read the following agreement and release and agree:

Please sign below:

Applicant______________________________________ Date________ 

Parent/Guardian________________________________ Date________
(Sign if applicant under 18 years)