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Responsible Organized Mountain Pedalers

Membership Application, Renewal, Change of Address, and Donation Form

ROMP is a group of local, energetic mountain bikers who have discovered the need for an active representation for the mountain biking public, and for an organized, responsible attitude in the practices of off-road bicyclists. ROMP needs YOUR support to help these changes come about.

Complete all information whether you are a new or renewing member. Failure to include all information will delay your membership. Please type all information, then print and sign the form.

Name
Additional names
(family membership)
Address
City
State
Zip
Phone
(including area code)
Email
Membership type New
Renewal
Change of Address (allow 30 days)
Donation
Amount enclosed Individual ($20.00)
Family ($25.00)
Student ($10.00)
Donation $
Newsletter Please mail me the newsletter each month
Don't bother, I'll just read it on the web and save a tree
Club directory Please list my name and Address Phone Email
Do not list me in the directory
I'd like to help with Literature distribution
Merchandise donation
Event hosting
Ride leadership
Release of Liability Agreement
Upon acceptance of my membership in Responsible Organized Mountain Pedalers (ROMP), and while participating in any group event sanctioned, sponsored or organized by ROMP, I hereby, for myself, my heirs, assigns, successors and administrators, release, waive and discharge any and all claims for liability or damages resulting from death, personal injury or damage to any property which may occur, or which may later become accountable to me as a result, directly or indirectly of my participation in ROMP events (group rides). I fully understand this release is intended to unconditionally release, in advance, ROMP from any and all liability pursuant to or arising from my participation in club events, EVEN WHEN SUCH LIABILITY ARISES OUT OF NEGLIGENCE OR CARELESSNESS ON THE PART OF ROMP, its members, officers, and representatives.
Signature _____________________________________ Date
Parent signature
(if under 18)		 _____________________________________ Date

Send this form with check payable to:

ROMP – Attention: Membership
PO Box 1723
Campbell CA 95009-1723

Did you complete all information, sign your name, and enclose your check?
Thank you, and welcome to ROMP!

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