Kennebec Valley Bicycle Club Membership Application Form

 

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