Bend Bella Cyclists 2019 Membership Form
Please fill out all sections and read and consent to the terms of the waiver in the last question.
Phone Number (xxx-xxx-xxxx)
I would like to use PayPal for this year's membership fee
Yes, I will pay by PayPal
No, I will send a check to Bend Bella Cyclists c/o Moe Slater, 61845 Red Meadow Ct, Bend, OR 97702
I already paid ... I'm just filling out the membership form.
Bend Bella Cyclists 2019 Waiver
I acknowledge that bicycling is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event/activity. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have sufficiently trained for participation in the event/activity and have not been advised otherwise by a qualified medical person. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event/activity holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events/activities. In consideration of my application and permitting me to participate in this event/activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from this event/activity, BEND BELLA CYCLISTS, their directors, officers, employees, volunteers, representatives, and agents, the event/activity holders, event/activity sponsors, event/activity volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event/activity, whether cause by the negligence of releases or otherwise. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this event/activity. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film, likeness to be used for any legitimate purpose by the event/activity holders, producers, sponsors, organizers and assigns. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
Agreement to Waiver
I hereby certify that I have read the waiver; and I understand and agree to its content.
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