Bike Burlington 2018 Members
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Email address *
What type of membership is this: *
Select Membership Option *
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Adult 1 First Member Name *
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Adult 1 Last Member Name *
Your answer
Adult 1 Member Age *
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Adult 1 Member Cell Phone *
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Adult 2 First Member Name
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Adult 2 Last Member Name
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Adult 2 Member Age
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Adult 2 Member Email
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Adult 2 Member Cell number
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1st Child Under 18 Name
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1st Child Under 18 Age
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2nd Child Under 18 Name
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2nd Child Under 18 Age
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Additional Children
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Street Address *
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City *
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State *
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Zip *
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Convenant not to sue: The undersigned, for and in consideration of the privilege of participating in events and activities organized and sponsored by Bike Burlington, Inc. Hereby convenants and agrees not to sue Bike Burlington, Inc. It's officers or agents for damages which may be incurred by the undersigned arising out of the negligence of Bike Burlington, Inc. it's officers or agents.
Date *
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Adult 1 Member Signature *
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Adult 2 Member Signature
Parent or Guardian if under 18 Signature
Emergency Contact Information Name *
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Emergency Contact Information Relationship *
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Emergency Contact Cell Number *
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Emergency Contact Other Number
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Provide any additional comments
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