FINANCIAL BURDEN *

Is the reason you chose the free membership due to financial burden? Don't worry, this information is strictly confidential! In an effort to make the cycling club more accessible, we will use this information to determine if you're eligible for a scholarship.

No

Yes

NAME *

First Name

Last Name

PHONE *

(###)

###

####

BIRTHDAY

MM

DD

YYYY

DISCIPLINES *

Road

Gravel

MTB

Strictly Paved Trails

Commuting

CX

FREE MEMBERSHIP *

I understand that the free membership does NOT entitle me to any discounts , whether that's from any vendor, on classes, clinics, or events.

I have read and understand

Release of Liability

While we plan for every Prairie Bloom Rider to have a safe experience, there are some inherent risks in choosing to participate in cycling, such as adverse traffic conditions, road conditions, weather, and the actions of motorists and other cyclists. By choosing to participate, you acknowledge that you are willing to assume these risks, and that neither Prairie Bloom Cycling Club nor its members, sponsors, or community partners are responsible for any damage that may occur.

I have read and understand