Bike Psycho Membership Application

Return completed form and fee to:

Bike Psychos

PO Box 652

Oak Lawn, IL 60454

Name __________________________________________
Street___________________________________________
City_________________________________State_______
Zip____________ Phone ___________________________
Email: __________________________________________
Birthday MM/DD (optional): ____ / ____

Individual Membership ($20): ____
Family Membership ($25): ____

Include all family member's names and children's ages (attach separate page if necessary)

Name __________________________________________ Age ______
Name __________________________________________ Age ______
Name __________________________________________ Age ______

Participation in all Bike Psychos Club activities is at the rider’s risk!

I understand that the Bike Psychos and its officers and members are not responsible for, and are not insurers of my personal safety during its club rides. I hereby release the Bike Psychos and its officers and members and I agree to hold them harmless from any and all liability arising from my having sustained any property damage or personal injury while participating in club rides and activities. Bike Psychos requires a certified bike helmet to be worn on all rides.

Date_______________

Guardian Signature_______________________________ (for children under 18)

Member Signature________________________________

Spouse Signature_________________________________