Please print out, fill out, include payment and mail to:    

MWBC, PO Box 233, Brunswick, Maine 04011

Name: ____________________________________________

Address: __________________________________________

City, State Zip: ______________________________________

Email Address: ______________________________________

Phone (Home/Work/Cell):______________________________

Membership Type and Dues (check one)

[ ] Individual $15

[ ] Family $20

[ ] Sustaining Open

MWBC is an active club with a need for help. Are you willing to be a MWBC Volunteer?

Please check all that activities that might suit your interests.

[ ] Steering Committee [ ] Maine Bike Rally

[ ] Ride Committee [ ] Bike Rodeo

[ ] Social Event Planning [ ] Maine Hospice Event in memory of Dan R. Michaud

[ ] Advertising and Publicity [ ] Bicycle Advocacy

[ ] Volunteer Coordination Committee

[ ] Ask me as needed

Comments:

Note: Ride activities require use of a bicycle helmet, designation of an emergency contact person, and parental signoff for cyclists under 18 years of age.

• I acknowledge that there is unavoidable risk of accidental harm in participating in any bicycling event, and agree to assume all such risks.

• I am at least 18 years of age (or have provided parental consent below) and agree to wear a helmet and obey traffic laws and bicycling rules of the road.

Date:

Signature:

Parent, (if under 18)

Please make checks payable to: MWBC  
(Annual Dues - Renewable by April 1 of each year)