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WESTERN PENNSYLVANIA WHEELMEN CLUB
MEMBERSHIP APPLICATION
Memberships are per calendar year. Persons under 18 can be accepted in a family membership only.
Membership Type/Duration Select One
INDIVIDUAL Annual Dues $17.00 New Renewal
INDIVIDUAL 3 Year Dues $48.00
To join the WPW Google group, Go to
https://groups.google.com/d/forum/wpwbikeclub
Click for Apply for membership
Join, get weekly ride updates
FAMILY Annual Dues $19.00
FAMILY 3 Year Dues $54.00
* = Required field
Name(s) *
Street Address *
City/State/ZIP *
Phone Cell
EMail * Make your check or money order payable to:
WPW Bicycle Club
P.O. Box 99684
Pittsburgh, PA 15233
Date //
Notes
RELEASE
In signing this release for myself and/or for the above named person (if under 18), I understand the intent of this release and agree to absolve all officers, members and associated entities be they individuals or organizations singly or collectively of all blame for an injury, misadventure, harm, loss or inconvenience suffered as a result of taking part in any activity associated with or related to the Western Pennsylvania Wheelmen.

SIGNED
SIGNED
SIGNED
SIGNED
SIGNED
(Each family member must sign. Typing the names in the online form is sufficient.)
Term
Term