Nanaimo Bicycle Club
Membership Form
Class of membership:
|
General |
$10.00 |
|
|
Family |
$20.00 |
|
|
Associate |
$10.00 |
|
|
General + 1st Jersey |
$40.00 |
|
I understand that my membership begins on the date that this application and accompanying fee are accepted by the Membership Director of the Club, and expires at midnight on the 31st December 1998. This application is made willingly and with intent that I shall uphold the Constitution and by-laws of the Club. I have completed the liability waiver and understand the implications of that waiver.
Dated:…………………………
Signed:…………………………
Liability Waiver
Name:. . . . . . . . . . . . . . . . . . . . . . . . Birth Date:. . . . . . . . . . . . . . Age:. . . . .
Address:……………………………………………………………………..
City:……………………………..Postal Code:……………………………..
Telephone:(Home)……………………(Work)……………………………..
Email:……………………………………………………………………….
Would you prefer your newsletter sent via email: yes/no.
My experience level is: Novice/Intermediate/Advanced
In case of emergency, contact:……………………………………………………………
Please note the following significant medical history:………………………………………….
……………………………………………………………………………………………..
Caution: All Bicycling Activities can be hazardous.
You must rely upon your own judgment at all times and you must accept sole responsibility for the consequences of your actions.
You are advised that this club is organized by volunteer, amateur personnel. While cycling is mainly a safe and enjoyable sport, there is a risk of discomfort, physical injury, or death.
I, the undersigned, acknowledge that the information provided above is true and correct. I further acknowledge that I am freely and voluntarily accepting any risk of loss, injury, or death arising from my participation in the events and activities of the Nanaimo Bicycle Club, and I forever release and discharge the Canadian Cycling Association, The Bicycling Association of British Columbia, the Nanaimo Bicycle Club, and the leaders and organizers of these groups from and against any liability for death, loss, or injury to myself, however caused, and also from and against any liability for loss of or damage to my equipment, however caused.
Dated:……………………..Signed:……………………………………..
Witness:………………………………………
Parent or Guardian:…………………………………(If under19)
I would be interested in helping out with the Coal Town Classic Bike Race. Yes/No