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DBTC Membership Form		DBTC PO Box 260517 Denver, CO 80226-0517
Total Enclosed: $___________	Make check or MO payable to: a
Type of Membership: q Individual ($25.00 per year) q Family ($30.00 per year)
q New Member q Renewal Are you willing to receive the newsletter via email? q Yes o No
q Please do not include my name when the club rents its mailing list to businesses providing services of interest to bicyclists.
Cycling Interests: qRoad qDirt/MTB Commuting qAdvocacy qFun qSocial Activities qSenior qTouring
Name:
Street:
City: State: Zip:
Home Phone: Work Phone: Cell Phone:
Email Address: Special Skills:
1st Member Name: YOB: Signature: Date:
2ndMember Name: YOB: Signature: Date:
3rd Member Name: YOB: Signature: Date:
4th Member Name: YOB: Signature: Date:
Print name, Year of Birth, sign and date above (IF UNDER 18, PARENT OR GUARDIAN MUST SIGN)
Applications without proper signatures will be returned. All adult members must sign. All minors must have an adult sign for them. In signing this release for myself or a member of my family who is under the age of 18, I acknowledge that I understand the intent hereof, and I hereby agree to and will absolve and hold harmless The Denver Bicycle Touring Club, Inc., and their officers, and members and any other parties connected with Club-sponsored rides in any way whatsoever, singly and collectively, from and against any blame or liability for any injury, misadventure, harm, loss, inconvenience or damage suffered or sustained as a result of participation in said Club-sponsored rides or activities associated herewith. I also hereby consent to and permit emergency medical treatment in the event of injury or illness. I shall abide by traffic laws and regulations and practice courtesy and safety in cycling. I also understand that the DBTC requires use of helmets as an important element for safe cycling.