WILD BETTYS MEMBERSHIP FORM
All applicants must complete and submit the entire form and a completed waiver
Member Information: (PLEASE PRINT CLEARLY)
Name: _______________________________________________________________________
Age as of Dec 31, 2012 : ______________________ Birth Date_____________________
Address: _____________________________________________________________________
City: __________________ Province: ______________ Postal Code: _____________________
Phone Number: _______________________________
Cell Number: ________________________________
Email Address: ________________________________
Emergency Contact Name: _____________________Emergency Phone:__________________
Member has a valid UCI OCA license. Yes _______ No _______
Riding experience(optional)_______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Membership: Cost is $65 payable by cheque, email melinda@wildbettys.com, or PayPal please
- covers the administrative costs of the OCA affiliation, insurance, website etc
- Protects the club & members against legal action.
- weekly rides, destination rides, Club Events
- Supports Ontario Cycling Association, which supports cycling at all levels in this area and across Ontario.
Submit Membership Application, waiver & Fee in one of following ways!
- on line, encouraged
- fax to (416) 929 3622
- by mail to Wild Bettys, 266 Douglas Drive Toronto, ON M4W2C1
- bring it along with payment on your first ride with us
Make cheque payable to Wild Bettys. Mail your cheque, application form(s) and signed waiver (one per member) to:
Wild Bettys
266 Douglas Drive
Toronto, ON M4W2C1
All information will be kept private & confidential to the Wild Bettys.
This form must be signed and returned before participating in club activities. There are no exceptions to this rule. Please print it out and fax it to 416 929 3622.