| ATLANTIC BICYCLE CLUB
MEMBERSHIP APPLICATION
SEND COMPLETED APPLICATION TO:
Atlantic Bicycle Club, P.O. Box 330,
Allenwood, NJ 08720 NAME ______________________ ___ BIRTHDATE _____ AGE _____ STREET __________________________ PHONE_______________ CITY, STATE, ZIP___________________ E-MAIL ADDRESS _______________ USCF CLASS ________CATEGORY __ LICENSE # ___________ EMERGENCY CONTACT: Name _____________PHONE ________ CIRCLE MEMBERSHIP TYPE:
INDICATE AREAS YOU WILL BE INTERESTED TO WORK IN: ___ CLUB RIDE/RACE ___ COACHING ___ TEAM/RACE SUPPORT ___ MOUNTAIN BIKE ___ TRACK RACING ___ TEAM DEVELOPING ___ NEWSLETTER ___ OTHER _______________________________ If accepted as a member of the Atlantic Bicycle Club Inc. I agree to abide by the Constitution and by-laws of the club. APPLICANT'S SIGNATURE _____________________________ DATE ________ WAIVER AND RELEASE In consideration of the acceptance of my membership in the Atlantic Bicycle Club, Inc.(hereafter referred to as "CLUB") I hereby agree to and make the following contractual representations and agreements. I fully realize the dangers of participating in bicycling and fully assume the risks associated with such participation including by way of example, and not limitation, the following dangers of collision with pedestrians, vehicles, other bicyclists, and fixed or moving objects: the dangers arising from surface hazards, equipment failure, inadequate safety equipment, and weather conditions: and the possibility of serious physical and or mental trauma or injury associated with bicycling. I hereby waive, release, and discharge myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest (hereinafter collectively "successors" ) any and all rights and claims which I have or which may hereafter accrue to me against the CLUB, its officers, members, representatives, assigns, agents, and any and sponsors, for any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association wit, or travel to or return from any and all Club functions, events or activities. I agree it is my sole responsibility to be familiar with planned courses or routes that may be taken and any special rules, regulations for such activities or functions. I understand and agree that situations may arise during the activities which may be beyond the immediate control of the organizers, and I must continually conduct myself so as to neither endanger myself or others. I accept responsibility for the condition and adequacy of my equipment. I have no physical or mental condition which, to my knowledge, would endanger myself and successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert any claim contravention of this agreement, I or my successors shall be liable for the expenses ( including legal fees ) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence. This agreement may not be modified orally, and a waiver of any provision shall not be construe a modification of any other provision herein or as a consent to any subsequent waiver of modification. SIGNATURE
___________________________________________ TODAY'S DATE
____________ SIGNATURE OF PARENT/GUARDIAN __________________________________ DATE _______ SIGNATURE OF WITNESS ____________________________ DATE ____________ | ||||||||
