Lawrence County Cycling Club
Membership Application
Name(s) ________________________________________________________________
Address_________________________________________________________________
City __________________________ State ______________ Zip _________________
Phone ________________________ Cell _______________________ 
May we publish your phone number(s) to other club members? Yes___ No___
Email Address _______________________________ Email newsletter and ride schedule Yes ___ No ____
Membership requested: Individual ____________ $10.00 Family ______________ $15.00
Are you or family members 18 or older? Yes ____ No ____
Membership is from January to December annual.
Waiver, I understand that I am responsible for my own bicycle, body, and safe conducton any club sponsored ride. I waive the club of any responsibility from injuries, which I inflict on others or to myself, and any damage I do to any equipment. I recognize that I am subject to all state and local traffic laws as any vehicle. 
If under 18, family member membership is required with parent or guardian.
Signature ______________________________________ Date __________________
Signature _______________________________________ Date __________________
Make check payable and mail to:
Lawrence County Cycling Club
c/o Bicycles and More
1907 W State St.
New Castle, PA 16101
Meetings are held the FIRST TUESDAY of each month at 7:30 pm at Bicycles and More