ROAD RAPTORS RIDING CLUB
 	   P.O. BOX 991
      O'Fallon, IL  62269-0991
      
       http://www.r3c.org

          Membership Application

Application Information:				Application Date:__________________
	Name:____________________________________________________________________
	Address:__________________________________________________________________
	City:___________________________________State:___________Zipcode:____________
        Profession:_________________________________________________________________
	Home Phone: ____________________________ Birthday:__________________________
	Email address:______________________________________________________________
Significant Other's Information:
	Name:____________________________________________________________________
	Address:__________________________________________________________________
	City:___________________________________State:___________Zipcode:____________
        Profession:_________________________________________________________________
	Home Phone: ____________________________
	Birthday:________________________________ Anniversary: ______________________
	Email address:______________________________________________________________
Family Members Names and Birth Dates:
Name			 Birthday			Name			Birthday
__________________	__________________	__________________	__________________
__________________	__________________	__________________	__________________
Motorcycle Information:
Year:_________ Make:_________________________ Model:____________________ Who Rides:______________
Year:_________ Make:_________________________ Model:____________________ Who Rides:______________
Year:_________ Make:_________________________ Model:____________________ Who Rides:______________
Additional Information:
Clubs: _________________________________________________________________________________
Hobbies:________________________________________________________________________________
Please make checks payable to Road Raptors Riding Club

Road Raptor's Dues Schedule


MONTH

INDIVIDUAL
MEMBERSHIP
KIDS UNDER 18 Family MEMBERHIP (Total for all)
Add to Individual Membership Total
January
$12.00
$6.00
February
$11.00
$5.50
March
$10.00
$5.00
April
$9.00
$4.50
May
$8.00
$4.00
June
$7.00
$3.50
July
$6.00
$3.00
August
$5.00
$2.50
September*
$16.00
$8.00
October*
$15.00
$7.50
November*
$14.00
$7.00
December*
$13.00
$6.50
* Membership fee includes dues for following year

All Memberships expire in January and must be renewed by that time


RELEASE, READ BEFORE SIGNING

I agree that the Road Raptors Riding Club, Inc. and their respective officers, directors and agents (hereinafter, the "RELEASED PARTIES") shall not be liable or responsible for injury to me (including paralysis or death) or damage to my property occurring during any club activity and resulting from acts or omissions occurring during the performance of duties of the Released Parties, even where the damage or injury is caused by negligence (except willful neglect).  I understand and agree that all Road Raptors Riding Club, Inc. members and their guests participate voluntarily and at their own risk in all club activities and I assume all risks of injury or loss to my person or property, which may result from my participation in club activities and events.  I understand that this means that I agree not to sue the Released Parties for any injury or resulting damage to myself or property arising from, or in connection with, the performance or their club duties in sponsoring, planning or conducting said events.

I further agree to waive all benefits flowing from any state statute, which would negate or limit the scope of this Release and Indemnification Agreement.

By signing this Release, I certify that I have read this Release and fully understand it and that I am not relying on any statements or representation made by the Released Parties.


Signature / Applicant: ___________________________________________________________


Signature / Significant Other: _______________________________________________________ 


Amount Paid___________________________________Date:______________________________
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