Long Island Bicycle Club Application for Membership
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Membership in the LIBC includes a 10% discount at selected bicycle shops, access to club rides and club meetings, and the monthly bulletin. The cost of membership is $20. There is and additional cost of $5 for each member of the household that wishes to join.

Name(s):___________________________________________________________
Address:___________________________________________________________
City:__________________________ State:______ Zip:_____________________
Phone:__________________ Email:___________________________________
Signature:_________________________________________________________
Additional Member(s) Signature:_______________________________________
LIBC membership: $20.00
___addit. members @ 5.00 each: _____
Total enclosed: ______

Make check or payable to:
Long Island Bicycle Club

Send this form and your payment to:
LIBC, c/o Maria Torres
5-14C 115 Street
College Point, NY 11356

 In signing this release for myself or a member of my family who is under the age of 18, I acknowledge that I understand the intent hereof, and I hereby agree to and will absolve and hold harmless the Long Island Bicycle Club and its officers and members and any other parties connected with club-sponsored rides or activities associated herewith. I also consent to and permit emergency medical treatment in the event of injury or illness. I shall abide by traffic laws and regulations and practice courtesy and safe cycling. I also understand that the Long Island Bicycle Club requires the use of helmets when participating in all club rides.
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