2005 CLUB PRINT AND SEND APPLICATION

NAME_______________________________________

ADDRESS____________________________________

CITY___________________________STATE________ZIP__________________

PHONE__________________________ CLUB DUES: $20.00 for 18 and over; $10 for under 18. Fees cover insurance at weekly training events and Team clothing discounts . 

Please fill out the information and return to the address below. make checks payable to Team ROAR

Racers of the Adirondack Region
c/o Keith Bombard
327 Turner Rd.
Morrisonville, NY 12962

AGREEMENT AND RELEASE OF LIABILITY

I acknowledge that cycling is an inherently dangerous sport in which I participate at my own risk and that Team ROAR is a non-profit corporation formed to advance the sport of cycling, the efforts which directly benefit me, hereby on behalf of myself, my heirs, assignees, and personal representatives, I release and forever discharge Team ROAR, USCF, and NORBA, its employees, agents, members, sponsors, promoters, and affiliates from any and all liability, claim, loss, cost or expense, and waive and promise not to sue on any such claims against any such person or organization, arising directly or indirectly from or attributable in any legal way to any action or omission to act of any such person or organization in connection with sponsorship, organization or execution of any bicycle riding, racing, or sporting event, including travel to and from such event, in which I may participate as a rider, team member or spectator.

I currently have no known physical or mental condition that would impair my capability for full participation as intended and expected of me (except for___________________________________________).

___________________________________________________    _________________________________
Signature of Applicant   (pen only)      Date

Parent or guardian of minor (under age 18): I as parent or guardian of the Applicant, represent to Team ROAR that the facts herein concerning my child or ward are true. I hereby give my permission for my child or ward to enter any bicycle ride, race or sporting event sanctioned by Team ROAR during the membership period applied for, and further, in consideration of granting of such a membership, agree, individually and on behalf of my child or ward, to the terms of the above Agreement and Release of Liability.

______________________________________   _________________________ 
Signature of Parent or Guardian (pen only)   Date

 

Racers Of the Adirondack Region