Dirt Divas Membership Application
Annual Membership dues are $25.00.  Your Dirt Divas membership includes organized weekly rides, monthly meetings, skills clinics, an opportunity to purchase and attend one of our weekend trips, participation on the race team, email reminders, newsletter, social events, the chance to purchase our cycling jerseys and socks, an invitation to the year end party, and much more!

Dues must be paid at the time this application is submitted.  All memberships expire on December 31 on a yearly basis.  

After filling out this form, you will be directed to PayPal to pay for your Dirt Divas membership where you may also make an optional charitable contribution.  While payment via PayPal is preferred, if you prefer to pay by check, please complete this form, submit the form electronically and mail your check for $40.00 payable to the Dirt Divas to:

Dirt Divas
ATTN:  Membership
P.O. Box 11813
Charlotte, NC 28220-1813

Questions?  Email membership@dirtdivas.net 
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Are you a new member or renewing member? *
Email address *
Mobile Phone *
Emergency Contact First and Last Name *
Emergency Contact Phone Number *
How did you hear about the Dirt Divas?
check all that apply
Who referred you?
(first and last name)
Date of Birth (MM/DD/YYYY)
Mailing Address Ln 1 *
Mailing Address Ln 2
City *
State *
Zip *
Cycling interest
(check all that apply)
Riding level
Clear selection
What type of clinics would you be interested in attending?
Other interests/hobbies
Anything else you want to tell us about yourself
Dirt Divas pride themselves on active involvement by all members.  Please let us know of at least one area where you would consider volunteering your time during the coming year. *
Method of Payment *
By clicking the checkbox option below, paying for your Dirt Divas membership, and submitting this form, you agree to the waiver included in the application as seen above. *
Waiver of Liability
In consideration of my membership into Dirt Divas, and of my own free will, I for myself, my heirs, executors and administrators, forever waive, release and give up any and all claims, demands, liability, damages, costs and expenses of any kind whatsoever (including personal injuries to me or my wrongful death) against the Dirt Divas and its Officers, Directors, employees, representatives, agents and contractors.  I fully realize the dangers of bicycling, which can include, but not be limited to, collision with pedestrians, vehicles, other riders and fixed or moving objects.  Dangers can arise from surface hazards, equipment failure, weather conditions or inadequate safety equipment.  I assume all risks associated with such participation or while driving to or from bicycling events.  I fully understand I am forever giving up, in advance, any right to sue or make any claim against the parties I am releasing if I suffer such injuries and damages, even though I do not know what or how extensive these injuries and damages might be, and am voluntarily assuming the risk of risk injuries and damages.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dirt Divas Inc. Report Abuse