West Texas cycling Association
Chaparral Cycling Club / Lubbock Bicycle Club
Membership Application
Name:___________________________ Address: ______________________________
City: ____________________________ State: ___________ Zip Code: ___________
Home Phone: _____________ Cell Phone: _____________ Work Phone: _____________
Email: ________________________________________ Your Birthday: __________
List additional family members:
Name: _________________ Gender: ____ Birthday: ___________ Age: ____
Name: _________________ Gender: ____ Birthday: ___________ Age: ____
Name: _________________ Gender: ____ Birthday: ___________ Age: ____
Name: _________________ Gender: ____ Birthday: ___________ Age: ____
Membership Type: (Please Check One)
_____ Individual $25.00
_____ Family - Primary $30.00
_____ Newsletter Only $15.00
_____ Student $10.00
I am interested in: ___ Weekly Rides ___ Touring ___ Racing ___ Triathlon ___ MTB
In consideration of being admitted to membership in the WTCA, I do hereby release and forever discharge (for myself, my heirs, administrators and executors) the WTCA, its officers, members, sponsors, and every other person who because of his or her position as an officer or participant in a WTCA event, of any type of liability to me for any injury or damage whatsoever that I may sustain or incur arising out of or as a result of any WTCA race, ride, or event of any type. I understand that under certain conditions, bicycle riding and racing may be hazardous to my person and health. I agree to indemnify and hold harmless the above-mentioned from and against all claims and actions by others for any act or omission on my part in connection with any WTCA event. I agree to ride safely at all times, to obeuy the traffic laws, and to wear a helmet.
Signature: _______________________________________ Date: __________________
(Parent or Guardian must sign for minor children)  
All memberships are active for a period of one year beginning on March 1. Memberships that begin after August 31 will only owe 50% of the normal yearly membership fee. Please indicate whether this is a Renewal or New Membership.
Please send your check (payable to WTCA) and this completed applicaiton to:
___ Check if this is a
Renewal
WTCA
C/O Treasurer
P.O. Box 94537
Lubbock, TX 79493
___ Check if this is a
New Membership