|
VCSMTB MEMBERSHIP APPLICATION
Last Name:______________________________________First Name:___________________________Middle
Initial:_________
Home Address:__________________________________City:____________________________State:_______Zip:__________
Home phone number:___________________________Work phone:________________________e-mail:__________________
Membership Type: New ($25)_____; Renewal ($15)_____; Under age 18 ($10)_____
Please
do/do not add my information to the Club website. (Only phone numbers and e-mail addresses are listed on the Club website).
Memberships run from January 1 through December 31. Joining after September 30 continues your membership through
the following year.
Please make checks payable to: VCS MTB Club, and mail, or drop off, along with this application
to:
VCS MTB Club, c/o Village CycleSport, 45 Arlington Heights Road, Elk Grove Village, IL 60007
THE FOLLOWING IS A RELEASE AND WAIVES YOUR LEGAL RIGHTS IN THE EVENT OF YOUR INJURY OR DEATH.
In consideration
of being permitted to be a member of the Village CycleSport Mountain Biking Club and to participate in Club rides and events,
including transportation to and from the same, I do hereby for myself, my heirs, executors, and administrators, RELEASE, WAIVE,
and FOREVER DISCHARGE the Village CycleSport Mountain Bike Club, its officers and members, and the Village CycleSport Shop,
its directors and employees from any and all claims, demands, actions, or the liabilities on account of any injury to me which
may occur from any cause whatsoever, including negligence or other fault on the part of anyone released hereunder, during
my participation in or transportation to or from said rides and events. I ACKNOWLEDGE THAT I AM AWARE OF THE RISKS AND HAZARDS
INHERENT UPON ENGAGING IN SAID CLUB ACTIVITIES, AND I DO SO ENTIRELY UPON MY OWN INITIATIVE, RISK, AND RESPONSIBILITY. I FURTHER
UNDERSTAND THAT THE CLUB DEPENDS UPON Its MEMBERS TO HELP IT PROVIDE AND LEAD CLUB ACTIVITIES AND THAT THOSE MEMBERS ARE RELYING
ON THE PROTECTION AFFORDED HEREUNDER. I hereby further agree to operate my bicycle in a manner that is safe to me and to those
around me, to observe all applicable safety regulations and to conduct myself in a manner that will be complimentary to the
sport of bicycling. It is my intent that this RELEASE and WAIVER apply at all times, notwithstanding that my membership in
the Village CycleSport Mountain Bike Club may have expired, lapsed, been renewed or been reinstated after a period or periods
of non-membership. I FURTHER ACKNOWLEDGE THAT I HAVE READ THE FORGOING RELEASE AND WAIVER, UNDERSTAND IT, INCLUDING THE IT
IS INTENDED TO COVER OCCURRENCES WHICH MAY NOT YET HAVE OCCURRED AND WHICH ARE UNKNOWN TO ME, AND NOTWITHSTANDING THE FORGOING,
I SIGN IT VOLUNTARILY WITH THE FULL INTENT THAT IT BE FOREVER ENFORCEABLE.
Signature:____________________________________________________________,Age:_________,Today's
Date:__________________.
Signature of legal guardian (if under 18):______________________________,
Relationship:____________, Today's Date:_______________.
|
