Membership Application for Major Taylor Cycling Club Chicago (“MTC3”)

Please print the below form. Complete the form and mail to:

MTC3 Membership Application

P.O. Box 4812

Chicago, IL 60680

Individual membership $25.00

$35.00 additional for family members and Adults 

New Membership [ ] Renewal Membership [ ] Annual Membership is from January 1st to December 31st

Name _______________________________________ 

Address______________________________________ 

City/State/Zip_________________________________

Home/Cell Phone______________________________   Email Address_________________________________

NOTE: You must be 18 years of age or older to be a member unless included under a family membership. List family members:

1)______________________________ 2)______________________________

3)______________________________4)______________________________

5)______________________________6)________________________________

In consideration of acceptance of my application for membership in Major Taylor Cycling Club Chicago (“MTC3”), I, for myself, my past, present and future agents, attorneys, representatives, predecessors, successors, assigns, heirs and executors, do waive, release and discharge MTC3, its past, present and future officers, directors, agents, employees, volunteers (including any individual giving a presentation, advice or information in conjunction with Bicycling), attorneys, any MTC3 members or event participants other than myself, parents, subsidiaries, predecessors, successors, affiliates, assigns, sponsors, representatives (the “MTC3 Parties”), officials and any involved municipalities or other public entities (including their respective agents and employees) from any and all manner of liability, claims for damages, causes of action, proceedings, compensation, attorneys’ fees, costs and expenses of suits, claims and demands whatsoever, which may arise in the future from my participation in Bicycling through or involving MTC3, including, but not limited to, any and all claims, losses or liabilities for death, injury, disability, property damage, medical bills, theft or damage of any kind, including economic losses, which may in the future arise out of or relate to my participation in or traveling to and from Bicycling through or involving MTC3. I acknowledge that there may be mode of transportation, persons, dangerous or adverse road or path conditions, hazards, wildlife or hidden objects present during Bicycling through or involving MTC3, and assume the risk related thereto of participating in Bicycling through or involving MTC3. I assume all other risks associated with participating in Bicycling through or involving MTC3, including contact or effects of other participants and effects of weather. I AGREE NOT TO SUE any of the MTC3 Parties for any and all claims made or liabilities assessed against them as discharged herein.

I hereby acknowledge that bicycle riding, bicycle racing and bicycling events (“Bicycling”) are strenuous activities beyond the capability of some people, and may cause minor, severe and/or permanent injuries or death to people who are not in sufficient physical fitness, training and/or experience. I have made my own determination as to whether I am able to safely participate in Bicycling. I recognize that the MTC3 has not evaluated my ability to participate in Bicycling. I also recognize that advice dispensed through MTC3 may not be appropriate for me, and it is my responsibility to make this determination. I acknowledge that some Bicycling is a test of a person’s physical and mental limits and carries with it, regardless of physical fitness or experience, the potential for death, serious injury and property loss. I assume the risks of participating in Bicycling. I certify that my level of fitness is appropriate to participate in Bicycling which I am voluntarily undertaking. I certify that I have sufficiently trained or prepared for the Bicycling I am undertaking and I have not been advised against participation in such activity by a

health care professional.

I INDEMNIFY AND HOLD HARMLESS MTC3 Parties from any and all claims made or liabilities assessed against them as a result of (i) my actions, inactions or negligence, (ii) the actions, inactions or negligence of the MTC3 Parties and others hereby indemnified, (iii) the conditions of the facilities, equipment or areas where the Bicycling is being conducted and (iv) any other harm, injury or damage caused by an occurrence related to or during Bicycling through or involving MTC3. It is further understood and agreed that this waiver, release and assumption of risk is binding on my heirs and assigns.

I GRANT PERMISSION for the use of my name and/or likeness relating to my participation in Bicycling of the MTC3 and I WAIVE all rights to any future compensation to which I may be entitled as a result of the use of my name or likeness.

I AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT

AND UNDERSTAND ITS CONTENTS.

Signature: __________________________________ Printed Name: ________________________ Date: ____________

ALL RIDERS ARE REQUIRED TO WEAR A BICYCLE HELMET.