Membership Application
Name:
___________________________________
Date:
___ญญญ___________________
Address: __________________________________ _________________________________________ Email: _________________________
Home phone: ______________________________ Work phone: _____________________
Terms
Jersey Size:
S_____ M_____ L_____ XL_____ In consideration of being permitted to participate in any way in Hawaii
Cycling Club (“Club” and “Releasee”) 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, in good health, and in proper
physical condition 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 permanent disability, paralysis, and death (“Risks”); (b) these Risks
and dangers may be caused by my own actions or inactions, the actions or
inactions of other’s participating in the Activity, the condition in which the
Activity takes place, or the negligence of the “Releasees” named below; (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 or that of the minor in the Activity. 3. Hereby release, discharge, covenant not to sue Hawaii Cycling Club,
the League of American Bicyclists, their respective administrators, directors,
agents, officers, members, volunteers, and employees, other participants, any
sponsors, advertisers, and, if applicable, owners and lessers 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 any 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, notwithstanding, shall continue in full force and effect. I further agree to wear an US “CPSC”
approved helmet during Hawaii Cycling Club rides as per club policy. Signature:
_________________________________________________Date: __________ If applicant is under 18 years of
age, this Release must also be signed by the parent or guardian. Please mail application and check to: Hawaii
Cycling Club, P.O. Box 3246, Kailua-Kona, HI 96745
1 year Individual Membership - without jersey
$25.00
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1 year Family membership - without jersey (add $60.00/jersey if desired)
$35.00
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2 year Individual Membership - with jersey
$80.00
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Jersey shipping charge (if you need it sent in the mail)
$5.00
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Release and
Waiver of Liability, Assumption of Risk, and Indemnity Agreement.
Signature of parent or guardian: _______________________________Date:
__________