Please print, complete, and mail in this form, or register online at the address listed below.

MEMBERSHIP APPLICATION

Bike Roswell! is a member-based, non-profit organization (application to be filed with the IRS) formed as a cycling advocacy group and to promote safe bicycling and the Share The Road message in Roswell, Georgia.  BikeRoswell! assisted the City of Roswell with its application for national designation as a "Bicycle Friendly Community" and will continue to work closely with the City with this effort and future efforts to promote cycling in Roswell.

PLEASE PRINT YOUR INFO and ALLOW 2-4 WEEKS FOR PROCESSING

Name _____________________________ DOB _____________ Gender ______

Address __________________________________________________________

City _______________________________ State _________ ZIP_____________

Home phone ________________________ Work phone ____________________

E-mail ____________________________________________________________

Membership: Family $25 [ ]    Individual  $15 [  ]

List family members and birth dates for Family Memberships:

Name: ___________________ birth date: _______________

Name: ___________________ birth date: _______________

Name: ___________________ birth date: _______________

Name: ___________________ birth date: _______________

Name: ___________________ birth date: _______________

Cycling is a rigorous potentially dangerous sport, the practice of which can result in serious, life threatening injuries.  In consideration of my membership, I agree not to hold Bike Roswell!, or any of its members and/or directors liable for any injury or damage, however caused, which may result from my participation in any race or event of any sort sponsored by or linked to Bike Roswell! and/or its affiliates.

Signature of Parents or Guardian, if under 18

_____________________________________

Make checks payable to Bike Roswell! and mail to:

Bike Roswell! - P.O. Box 745 Roswell, GA 30077-0745