2018 Velo Atlanta Cycling Club Membership Application
Welcome to Velo Atlanta Cycling Club! We're pleased you've decided to join/re-enroll in our club. Please take some time to fill out our membership form which also includes a link to PayPal where you'll be directed to pay your annual dues.

If you prefer to pay by check, please complete this form, submit it, and send your check separately to:

Velo Atlanta Cycling Club
P.O. Box 5324
Atlanta, GA 31107

All memberships expire December 31, 2018. If you join after October 31st, you will be granted membership for the remainder of the current year AND all of the next year.

Email address *
First Name *
Your answer
If renewing, how many years have you been a member of Velo Atlanta Cycling Club?
Your answer
Last Name *
Your answer
Are you a new member or renewing? *
Date of Birth (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Mailing Address
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Street *
Your answer
Contact Info
How did you find out about Velo? *
Your answer
Occupation
Your answer
Mobile Phone *
Your answer
Years Road Bike Riding *
Your answer
Do you have any interest in road racing?
Our club desires to assist and encourage all our members in successfully achieving their cycling goals whatever they may be. In order for this to occur we understand it takes deliberate effort on the part of each member. Therefore, we would like to secure a participation commitment from each member. Please select at least one area in which you would be willing to volunteer your time during the coming year. *
What type of bike clinic would interest you?
Do you have any interest in triathalons?
Emergency Contact (Name and Phone Number) *
Your answer
Please agree to waiver below and continue for payment options
(WAIVER MUST BE SIGNED BY EACH MEMBER)
Waiver Information
I, hereby apply for membership in Velo Atlanta Cycling Club. I acknowledge that by signing this document, I am releasing Velo Atlanta Cycling Club, its members, directors, officers, attorneys and employees from liability of any kind.

I ACKNOWLEDGE THAT CYCLING IS AN INHERENTLY DANGEROUS SPORT AND INVOLVES RISKS AND DANGERS OF DAMAGE TO PERSONAL PROPERTY AND SERIOUS BODILY INJURY.

Serious bodily injury includes permanent disability, paralysis, and death (“risks”). I understand that these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in any activity. I understand that there may be other risks, 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 responsibility for losses, costs, and damages I incur as a result of my participation. I understand and agree that I will participate in all club activities at my own risk. I further understand and agree that the club is a corporation that provides cycling activities for its members and for the advancement of the sport, which will be a direct benefit to me. Therefore, on behalf of myself, my heirs, successors, assigns, and personal representatives, I HEREBY WAIVE, RELEASE, HOLD HARMLESS, DISHCARGE, INDEMNIFY AND PROMISE NOT TO SUE VELO ATLANTA CYCLING CLUB, its members, directors, officers, attorney and employees (collectively the “Released Parties”) from any and all rights and claims including those arising from the Released Parties’ own negligence, which I have or which I may hereafter accrue from any and all damages sustained by me of any kind directly or indirectly in connection with, or arising out of, my participation in any training/club rides or other activities run, sponsored, promoted, or encouraged by the club or travel to or return from such activities (“Activity”). I represent that, based upon a recent physical examination by a licensed medical provider, to the best of my knowledge I have no medical or physical that would affect my ability to participate in any club event or that my participation would endanger my health. I acknowledge that I have been advised to read this entire document carefully, that I agree to abide by the promises I am making in this application and that I am knowingly and voluntarily signing this application. I understand that the club is relying upon my promises in this application and would not grant me membership in the club without my promises. I agree to abide by all of Velo Atlanta Cycling Club’s rules, regulations and bylaws.

By clicking the “I accept” option below, paying for your 2018 membership, and submitting this form, you agree to the waiver included in this application as seen above. *
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