Name: ________________________________Address:                                                                                  
(Please print)  
City:                                                                     State:                  9-digit Zip:                    --                _ 

Phone: (___)______--_________E-Mail: ___________________________________  

Emergency Contact: ____________________________________Phone #_____________________  

Birthday (month & day only) _____________   Newsletter (check one) Electronic  o   Paper o

New member:  o                    Referred by: _____________________                 Renewal:  o
  
In submitting this application to be a member of the Lone Star Cyclists Club, I undertake to ride safely at all times. 
I understand that a bicycle is a vehicle and subject to the State of Texas laws as stated in the Texas Drivers  
Handbook. I also understand that the Lone Star Cyclists encourages each member to wear an ANSI or Snell approved bicycle helmet as it greatly reduces the risk of serious, permanent injury. Finally, I understand that I participate at my own risk and herby release Lone Star Cyclists, its officers, and other members from any claims, demand rights or clauses, present or future, whether known, anticipated, or unanticipated, resulting from or arising out of, or incident to, whole or part,  my participation in the bicycle rides and related club activities, whether or not caused by negligence of the parties released hereby.

My riding pace average is (circle one):  Easy (11.9mph or less)   Moderate (12-14.9mph)   Fast (15+mph)

Please circle the activities for which you would volunteer your help and services: Officer--Ride Leader--Special Events--
Membership--Web site--Newsletter--Tour d' Italia--Telephoning-Other ____________________________

Signature:                                                         Date:                          _