CHATHAM-KENT
BICYCLE CLUB
a chapter-affiliate of Cycle Ontario Alliance
MEMBERSHIP REGISTRATION
FORM
Fee is $30.00 for membership to December 31 2007.
| Name1: |
| Street Address: |
| Community |
| Province:Postal Code: |
| Phone #: Work:Home: |
| E mail address: |
| Name2: |
| Street Address: |
| Community |
| Province: PostalCode: |
| Phone #: Work:Home: |
| E mail address: |
| I'm interested in the following cycling
activities: -Local group rides - Cycle skills training -Multi-day tours -Other (Please List) |
| I think that the following issues are the
most important ones affecting Chatham-Kent cyclists: |
| These are some of the best ways that cycling
in Chatham-Kent can be improved : |
| I would be interested in volunteering
in the following area(s): -Serve on the club executive committee -Lead local group rides -Build/maintain offroad trails -Lead group commutes to&from my workplace or school -Organize a Bicycle Users Group at my workplace or school Please name your workplace or school |
| Membership Fees (Includes membership in Cycle Ontario Alliance): |
| Single membership: $30 for one year, $50 for 2 years $ |
| Family membership: $55 for one year, $90 for 2 years $ |
| PAYMENT BY : CARD #EXPIRY DATE: |
OTHER COMMENTS:
IN SUBMITTING THIS FORM, I
AGREE TO THE RELEASE,
WAIVER, AND INDEMNITY
AS IT APPEARS BELOW.
RELEASE, WAIVER, AND INDEMNITY
In consideration of my application for participation in cycling activities through Chatham-Kent Bicycle Club, I understand that I am legally responsible for myself, and I for myself, my heirs, executors, successors and assigns, HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE Chatham-Kent Bicycle Club, their agents, employees, servants and representatives OF AND FROM all claims, damages, costs, expenses, actions, and causes of actions, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reasons of my participating in their activities, AND NOTWITHSTANDING that same may have been contributed to or caused by negligence of Chatham-Kent Bicycle Club, its agents, employees, servants, or representatives.
I FURTHER UNDERTAKE TO HOLD AND SAVE HARMLESS and AGREE TO INDEMNIFY all the aforesaid from and against any and all liability incurred by any or all of them, arising as a result of or in any way connected with my participation.
I ACKNOWLEDGE HAVING READ, UNDERSTOOD, AND AGREE to this Release, Waiver, and Indemnity. I warrant that I am physically fit to participate in tcycling activities and that all my equipment is mechanically fit for its intended use.