Nitc Membership 2010

North Iowa Touring Club Membership Application P.O. Box 1281 Mason City, Iowa 50402 North Iowa Touring Club North Iowa Spin

Mason City Multisports

Name: _______________________________ Address _________________________________ City: ___________________________ State ____________________ Zip Code _____________ Email: _______________________________________ (This should be an email you check frequently) Home Phone: ___________________________ Office Phone: ___________________________ Cell Phone: _________________________ Emergency contact: __________________________ Parent/Spouse/Significant Other: ______________________________ Age in 2010 (Race Age): ____________________ Date of Birth: _________________________ Road/Cross/MTB Cat: ___________ Licensing Authority: __________ License No. _________ Running Category: _____________ Licensing Authority: ___________License No. _________ Triathlon Category: _____________ Licensing Authority: ___________ License No. _________ Circle areas of Interest: Cross Country Skiing * Downhill Skiing * Canoeing * Cycling (all genres) * Walking* Swimming Running * Teach others * Help Organize * Hiking * Camping * Sailing* Snow Shoeing

North Iowa Touring Club1 Single or Family North Iowa Spin/MC22 (single or family) Total

$15.00 By signing this $20.00 membership application, $15.00 Optional you you acknowledge understand that training, participating and competing in all sporting events are potentially dangerous activities. You agree to hold the North Iowa Touring Club, North Iowa Spin, and Mason City Multisports, their members, officers, sponsors, and all other persons and organizations associated with North Iowa Touring Club, North Iowa Spin, and Mason City Multisports harmless should you be injured or killed. Further, by signing this contract you agree to bind yourself, your heirs and all personal representatives. The time period of this contract shall commence on the date signed through December 31, 2008. Signature: _______________________________________ Date: ________________________ Printed Name: ________________________________________ Signature of Junior Rider’s Parent/Guardian: _________________________ Date: __________.

[1] NITC membership runs from January 1 – December 31. For new NITC members this membership will include remaining 2009 and 2010 memberships. [2] All members of NISPIN and Mason City Multisports must be members of the North Iowa Touring Club.