Prescott Chain Gang Bicycle Club Membership Application  
http://www.surf-ici.com/chaingang
(Must be printed, filled out, signed, and mailed with a check or money order to the address below)

Membership in the Prescott Chain Gang includes membership in the Pheonix based Greater AZ Bicycling Association (GABA).   This includes a subscription to GABA's newsletter that is printed and mailed each month and contains information about cycling events and issues in AZ.  GABA membership entitles you to discounts on its events held around AZ.  Chain Gang Membership also includes a 10% discount on bike accessories at High Gear Bicycles 520-445-8417 and Bikesmith's Cycling and Fitness 520-445-0280.   The Prescott Chain Gang does not print a newsletter but instead Emails a monthly newsletter "Chain Mail" to all members that have access to Email.    The Ride Schedule, Chain Mail, and all other club information  is available at our web site located at the URL above.  Members that do not have Email or Internet access can pick up a printed copy of the Chain Mail and Ride Schedule at High Gear Bicycles and Bikesmith's Cycling and Fitness. 

Please make checks payable to
the Prescott Chain Gang Cycling Club and mail to:

Prescott Chain Gang Cycling Club
P.O. Box 3570
Prescott, Arizona 86302

Membership Information

Family ___$17.00 Individual ___ $14.00  New___ Renew___


Name________________________(If this is a family membership please list names below)
Mailing Address Email Address___________________________

 
Home Phone_____________________Work Phone__________________________

What Type of riding do you do?

Road ___ Mt. Bike (dirt Rd. only)___ Mt. Bike (Rd. and trails)___ other___________

What is Your Level of Fitness?

Beginner ___ Intermediate ___ Advanced ___ other _____________________________

In consideration of the acceptance of my application I hereby waive, release, and discharge any and all claims any and all claims for damages, for death, personal injury or property damage which I may have or which may hereafter accrue to me, as a result of my participation in this club.  This release is intended to discharge in advance the officers and members of the Prescott Chain Gang Bicycle Club from and against any and all liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.  I further understand that serious accidents occasionally occur during bicycling; and that participants in bicycling occasionally sustain mortal or serious personal injury, and/or property damage, as a consequence thereof knowing the risks of bicycling, nevertheless, I hereby agree agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or my heirs or assigns) for damages.  It is further understood and agree agree that this waiver, release and assumption of risk is to be binding on my heirs and assigns.

SIGNATURE_____________________________________________DATE__________________________
Parent/Guardian signature if under 18.  If participants are under 16 they must be accompanied by a responsible adult