El Paso Bicycle Club Membership Application Form

Please complete all the required (*) fields.
Information you enter on this form will be transmitted
to the El Paso Bicycle Club's Membership Coordinator for
processing your application.
This application must be submitted AND paid in order to be processed.
By submitting this form you will be transferred to
a payment page, where you can make secure payment through PayPal.

* REQUIRED APPLICANT INFORMATION

First Name: * Last Name: *

Address: *

City: * State: * Zip: *

Phone Number: *

Work Number (optional):

Cell Number (optional):

E-Mail Address: *

Type of Membership Requested: * (choose one)

1 Year Individual Membership $18
2 Year Individual Membership $30
1 Year Family Membership $25
2 Year Family Membership $44
Military: First year free.

* Please indicate if you wish to have your
name, address, phone number and email address listed
in a club membership directory which will be
distributed only to club members.

Yes, please add my information to the club directory.
No, please do NOT add my information to the club directory.

If you chose "Yes" to adding your information to
the club directory, please select the items you wish to
include on the club membership directory:

eMail Address.
Phone Number.
Home Address.

EPBC Liability Release Notice

The applicant (parent or guardian for persons under 18 years of age) represents and warrants that he/she possesses sufficient bicycling skills and competence to negotiate any and all road conditions that may be encountered on the proposed routes and that his/her bicycle is maintained in a safe operating condition. An ANSI or SNELL certified helmet is required on every ride. The applicant acknowledges that he/she has read this release, understands its terms, and intends to be legally bound and agrees on behalf of the applicant and his/her heirs, executors, administrators to release and hold harmless the El Paso Bicycle Club, its officers, members and or representatives for any and all blame or liability (including without limitation, liability for negligence or gross negligence) for any injury, damage, loss or inconvenience that may be experienced in connection with activities designed and conducted by the El Paso Bicycle Club.

BY CLICKING ON THE "I AGREE" BUTTON YOU ACKNOWLEGE THAT YOU HAVE READ THIS AGREEMENT, UNDERSTAND IT AND AGREE THAT YOU AND ANY FAMILY MEMBERS INCLUDED IN YOUR MEMBERSHIP ARE BOUND BY ITS TERMS AND CONDITIONS.
or PLEASE NOTE: By clicking on the "I Agree" button
you will be transferred to the PayPal payment page.
Your application will not be accepted without payment.