Mount Adams Cycling Membership Application

Membership Fees for 2011:  $20.00 per individual or $25.00 for couples/families

Payment:  Please download a membership form. After completing the form, mail it in with your check to:

MOUNT ADAMS CYCLING
P.O. Box 745
Yakima, Washington 98907

word file Download the Membership Application in Word

pdf file Download the Membership Application in PDF. You will need the Adobe Reader to view the pdf version of the form.

Online Membership Renewal and Payment

Step 1 - Complete the Online Membership Form

To join and pay your membership fee online, complete and submit the following form:

Select your current Membership Status


Membership Category

- $20.00
- $25.00

I would like to make a donation to promote Safe Cycling in Yakima: $

All fields marked with an asterisk are required, including the waiver and release. Please complete the entire form.

Name(s)*
Address*
City*
State*
Zip Code*
Home Phone*
Work Phone
Cell Phone
Email address*
Emergency Contact Name*
Emergency Contact Phone*

Waiver and Release*

In consideration of the acceptance of my application for membership in Mount Adams Cycling, I hereby waive, release and discharge all claims for death, personal injury, or property damages which I may have or which may hereafter accrue to me as a result of my participation in Mount Adams Cycling activities. I realize there are many dangers inherent in the sport of cycling, and I assume the risk of injuries that my result from those dangers, including death and/or serious bodily injury.  This release is intended to discharge Mount Adams Cycling, the sponsors and agents from and against any and all liability arising out of or connected in any way with my membership in Mount Adams Cycling, even though that liability may arise out of negligence or carelessness on the part of persons or entities mentioned above.  This waiver and release shall be binding on my heirs and assigns. I also hereby agree to wear an ANSI and/or SNELL approved helmet when participating in any Mount Adams Cycling activity to include, but not limited to rides, races, tours and events.

After clicking submit, you will be directed to PayPal where you can make the payment for your membership via credit card or direct withdrawal.