WILLIAMSBURG
AREA BICYCLISTS MEMBERSHIP APPLICATION
New or Renewal (circle one)
Please print each name as it should appear on
the membership card. If family give ages of children after each name
Name(s):
_______________________________________________________________
Name(s): _______________________________________________________________
Address: _______________________________________________________________
City, State, ZIP:
__________________________________________________________
Home Phone: _________________________ Cell Phone: ______________________
E-Mail:
_________________________________________________________________
Type of Membership:
Please do NOT give my name to other
bicycling organizations.
Reasons for joining:
Your riding
preferences:
Road Off-Road
Distance (miles):
Speed:
Please check any of the following areas
which may be of interest to you:
Please check if you
wish to receive a hard copy of the WAB newsletter. Newsletters will be
sent electronically if not checked.
Please sign Release Form and mail with check to:
Williamsburg Area Bicyclists, PO Box 2222, Williamsburg, VA 23187-2222 Williamsburg
Area Bicyclists Release Form and Liability Waiver
Important:
This is a legal document. Please read and understand before signing. If
you have any questions, consult an attorney.
In
consideration of being permitted to participate in any way in
Williamsburg Area Bicyclists, Inc. ("club") sponsored activities
("activities") I, the undersigned, freely acknowledge and realize the
dangers of participating in the activities and fully assume all risks
including, but not limited to, collision with pedestrians, vehicles,
other riders, and/or fixed or moving objects, the negligence of other
riders, sponsors, promoters or drivers, and dangers arising from falls,
road surface, equipment failure, inadequate safety equipment, weather
conditions, as well as the possibility of physical and/or mental trauma
(or injury). I understand that any route or activity chosen as part of
our outdoor adventure may not be the safest, but has been chosen for
its interest or challenge. I understand that the route requires
bicycling on public roadways and in bad weather and that cyclists have
been hospitalized and/or killed because of traffic mishaps that are
either their responsibility or others' responsibility. I further agree
that I will bear all expenses incurred in any such accidents. I realize
the activities require physical conditioning and I represent that I am
in sound medical condition. I have no physical or medical impediment
which would endanger myselfor others. I understand and agree that a
situation may arise during an activity which may be beyond the control
of the sponsors, promoters, or organizers and agree to ride so as not
to endanger either myself or others. I will wear an ANSI or SNELL
certified helmet when riding a bike during the club rides. I will obey
all applicable traffic laws and regulations. I understand if I leave
the route, I am no longer on the ride.I waive, release, discharge for
myself, my heirs, executors, administrators, legal representatives
(including successors), any and all rights and/or claims which I have,
may have or may hereafter accrue to me against the sponsors and
promoters of the club, or other sponsors or affiliated organizations
and their respective agents, officers, and employees for any and all
damages, injuries or claims which may be sustained by me directly or
indirectly arising out of my participation in the activities. The above
agreements and representations are my express understandings of the
risks and I assume these voluntarily and freely without coercion or
duress. This agreement may not be modified orally and may not be waived
in any respect. I accept responsibility for the condition and adequacy
of my bicycle.
Dated this ____________ day of
____________________, 2007
Signature(s):
____________________________________________________________
Printed Name(s):
_________________________________________________________
PARENT/GUARDIAN RELEASE
Everyone under eighteen (18) years of age must have the following
completed:
I as parent or guardian of the above named minor
hereby give my permission and consent voluntarily and freely for my
child to participate in the club activities. I further agree
individually and on behalf of my child to the above terms after having
fully read the "Release and Liability Waiver."
Signature(s):
____________________________________________ (parent or guardian)
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