MOUNTAIN BIKE CLUB MEMBERSHIP APPLICATION
Please fill in all applicable blank lines. Please print. Read and sign the Liability and Indemnification Agreement below. Please make checks payable to: KICKAPOO MOUNTAIN BIKE CLUB.
Emergency Contact Name & Phone:_______________________________________________________________
Membership Type (circle one): Single ($10.00) Family ($15.00) Junior ($5.00)
Payment Method (circle one): Check PayPal
If a family membership, please indicate the names and ages of each member of the family to be included:
Where did you learn about the KMBC?____________________________________________________________
I/We understand and agree that this application is subject to the policies, rules, regulations, and by-laws of the Kickapoo Mountain Bike Club, in force at this time or at any time in the future. I/We hereby agree to and will pay membership due in the amount determined by the Board of Directors of the Kickapoo Mountain Bike Club.
RELEASE OF ALL LIABILITY AND INDEMNIFICATION AGREEMENT
I/We acknowledge that the sport of bicycling is a dangerous activity that can result in personal or bodily injury, included but not limited to or loss of personal property, including but not limited to, bicycling equipment. Furthermore, in consideration for the privilege of submitting this application, I/we on behalf of myself/ourselves individually, and on behalf of all family members under the age of twenty (20) LISTED ABOVE, and on behalf of my/our and their heirs, executors, administrators, or assigns, hereby agree to and will indemnify the Kickapoo Mountain Bike Club, its officers, directors, and its agents and hold them harmless from any suits, filing fees, costs of collection, and attorney fees.
I/We have read the foregoing APPLICATION AND RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT and understand all of the terms thereof. I/We execute it voluntarily and with full knowledge of its significance.
ALL ABLE APPLICANTS MUST SIGN:
SINGLE MEMBERSHIP is for any adult (18 years or older) wishing to join the Kickapoo Mountain Bike Club. A single membership may be converted to a family membership by filling out a new application and paying the $5.00 difference.
JUNIOR MEMBERSHIP is for minors under 18 whose parents are not members of the Kickapoo Mountain Bike Club.
Office Use Only: Date Received_____________ Number of Members_____________ Amount Enclosed_____________