Memphis Hightailers Bicycle Club - Membership Application

MHBC Membership Application

You can now renew your membership online at Active.com. It's easy and convenient. Click here to begin.

Print this form and submit it with your membership fees by mail

Name:
Address:
Address:
City:	State:	Zip:
Phone:	Birth Date:
Occupation:
E-mail:

Membership type:	Renew	New Member
	$20	1-Year Individual
	$35	2-Year Individual
	$25	1-Year Family
	$45	2-Year Family
Additional names in family:



Bicycling Interests: check all that’s applicable	Touring	Racing	Club Rides
	Off-Road	Fitness	Centuries
	Commuting	Other:

I found out about the MHBC from:	Local bike shop(s)
	Friends
	Listing in the newspaper
	Other club(s)
	Through the Internet/Web
	Other:

For in consideration of the acceptance of my Application in the Memphis Hightailers Bicycle Club, I hereby waive, release and discharge in advance the Memphis Hightailers Bicycle Club, its officers, members, and persons acting in concert with them (all of whom are referred to herein as MHBC), from any and all claims which may hereafter accrue to me, or to any other person(s) as a result of participation in any event involving MHBC. I represent that I am in good physical condition, and that I have sufficient skill and experience to safely complete any bicycle ride or tour in which I choose to participate. I realize that in bicycle riding there is the possibility of accidental or other physical injury and that property damage and serious injury can occur as a result of bicycle riding. Knowing the risks, I agree to assume the risks, agree to release, hold harmless and to indemnify MHBC from any and all liability to MHBC by either me or any third party as a result of my participation in any event involving MHBC. I agree that the undertakings set forth in the paragraphs shall remain in force and effect until I cease to be a member of MHBC or as a participant in this event.

Signature:
	(Youth Members must have signature of parent or guardian)


Reminder: make check payable and mail to: Memphis Hightailers Bicycle Club C\O Barry Smith 2498 Grovewood Cove Germantown, TN 38138 Your membership is not effective until we receive your membership fees.