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Application

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Print this page out and send to us along with a check at the following address:

Out-Spokin' Wheelmen
P.O. Box 838
Youngstown, OH 44501

Membership type: [ ] Individual $15 ; [ ] Family $20

Name:________________________________ Birthday:_____________

Address:____________________________________________________

City:__________________ State:______ Zip:__________

Phone:______________(H) ______________ (W) Email________________________

Family Members:

Name__________________________________ Birthday:____________

Full membership rate March1-Sept. 30; Half membership rate after October 1

Waiver: I understand that I am responsible for my own bicycle, body, and safe conduct on any Club sponsored activity or ride. I waive the Club responsibility from any injuries which I inflict on others or to myself, and any damage I do to any equipment. I recognize that I am subject to all state and local traffic laws as a vehicle. If under 18, a family membership is required with parent or guardian.

Signed:_________________________________ Date:__________________