KENNEBEC VALLEY BICYCLE CLUB - MEMBERSHIP
APPLICATION
In consideration of being permitted to participate in
any way in the Kennebec Valley Bicycle Club (KVBC) sponsored Bicycling
Activities (“Activity”) I for myself, my personal representatives, assigns, heirs,
and next of kin:
1. Acknowledge, agree and represent that I understand
the nature of Bicycling Activities and that I am qualified to participate in
such Activity. I further acknowledge that the Activity will be conducted over
public roads and facilities open to the public during the Activity and upon
which the hazards of traveling are to be expected. I further agree and warrant
that if at any time I believe conditions to be unsafe, I will immediately
discontinue further participation in the Activity.
2. Fully understand that: (a) Bicycling
Activities involve risks and dangers of serious bodily injury, including viral
infections, bacterial infections and other communicable diseases and illnesses,
permanent disability, paralysis and the risk of death; (b) these risks and
dangers may be caused by my own actions, or inactions, the actions or inactions
of others participating in the Activity, the condition in which the Activity
takes place, or the negligence of the other participants; (c) there may be other
risks and social and economic losses either not known to me or not readily
foreseeable at this time; and I fully accept and assume all such risks and all
responsibility for losses, costs, and damages I incur as a result of my
participation in the Activity.
3. Hereby release, discharge, covenant not to sue, and
agree to indemnify and save and hold harmless KVBC, the League of American
Bicyclists (LAB), their respective administrators, directors, agents, officers,
members, volunteers, and employees, other participants, any sponsors,
advertisers, and, if applicable, owners and lessors of premises on which the
Activity takes place, (each considered one of the “releasees” herein) from all
liability, claims, demands, losses, or damages on my account caused or alleged
to be caused in whole or in part by the negligence of the “releasees” or
otherwise, including negligent rescue operations; and I further agree that if,
despite this release and waiver of liability, assumption of risk, and indemnity
agreement I, or anyone on my behalf, makes a claim against any of the
“releasees”, I will indemnify, save, and hold harmless each of the “releasees”
from any litigation expenses, attorney fees, loss, liability, damage, or cost
which may incur as the result of such claim.
I have read this agreement, fully understand its
terms, understand that I have given up substantial rights by signing it and
have signed it freely and without any inducement or assurance of any nature and
intend it to be a complete and unconditional release of all liability to the
greatest extent allowed by law and agree that if any portion of this agreement
is held to be invalid, the balance, not withstanding, shall continue in full
force and effect.
EVERY HOUSEHOLD MEMBER WHO WILL PARTICIPATE IN CLUB
ACTIVITIES MUST SIGN THIS RELEASE FORM. (Please contact our Membership
Coordinator if any individual described on this application is between 16 &
18 years of age.)
Signature:
________________________________________________ Date:
___________________________
Additional Signatures:
_________________________________________ Date: ___________________________
____________________________________________________________________________________________
Name and Address (Please Print)
Name(s): _________________________________________________
Date of Birth: ________ Sex (circle) M F
__________________________________________________
Date of Birth: ________ Sex (circle) M F
Address:
__________________________________________________________
Town: _________________________State: _____________Zip
Code: ________
Home Phone: __________________ Cell Phone:
___________________ e-mail: __________________________________
KVBC Membership Dues: 1 Year - Individual: $10.00; 1
Year - Household: $15.00
Electronic Payment via Venmo at this link: https://www.venmo.com/u/Brian-Bowker-4
Or, make check or money order payable to: Kennebec Valley
Bicycle Club
Send your payment with this completed form to:
B. Bowker, Treasurer or D. Crowell, Membership
Coordinator
434 Frederick Corner Road, Norridgewock, Maine 04947
.JPG)
.JPG)
.JPG)
