Membership application
All memberships are for the calendar year, and expire on December 31st. (Note: Memberships accepted after September 1st are valid through the follwing year.) Dues are $15 for individuals ($20 for USCF/NORBA licensed riders with clubs other than QCW on their license), $7 for Juniors (under 18), and $20 for families.
Date:
Name:
Additional Names (Family memberships only):
Address:
Phone:
Email:
Birthdate:
Do you currently hold a racing license?
USCF#:
Club:
NORBA#:
Club:
Waiver
In submitting this appication for membership in the Queen City Wheels, Inc., I understand that bicycle riding is inherently dangerous. I do hereby for myself, my heirs, executors and administrators, release, and forever discharge any and all rights and claims for or to be for which I may have or which hereafter accrue to me against the Queen City Wheels, Inc., including officers, administrators, ride leaders, individual members(s), officials, coaches, and volunteers, and or any other parties connected with events sponsored by Queen City Wheels, Inc., individually or collectively, from all responsibilities for any injury to persons during such events.
Applicant Signature:
Signature of Parent or Guardian if under 18:
Return to:
Queen City Wheels, Inc.
185 Albright Dr.
Loveland, OH 45140
For further information, call 677-PELO