(Racing is for 30+ years and juniors)
O Annual Racing Membership in BCMCA -- $30/year O Hold Race License
O Race Day Membership $5/per day of race
O Cycling BC Citizen Race License $45/year day of race (includes $3 administration fee)
Note: A racing license is required to race in BCMCA events. It provides accident and liability insurance while racing. (Information at Cycling BC 604-737-3034.)
Cheques payable to: BCMCA, c/o PO Box 157, Shawnigan Lake, BC, V0R 2W0
(Please print.)
Name __________________________________________________________
Address ________________________________________________________
Postal Code ____________________
Phone _______________ Mobile ______________ E-mail _____________
Date of birth ______________________ Age you attain in 2010 ________
Group (sex and age) ________
e.g. Male 30-34, M 35-39, M 40-44, etc; Female 30-34, F 35-39, F 40-44, etc.
WAIVER, SAFETY AFFIRMATION AND RELEASE
In consideration of the acceptance of this membership application and of being allowed to participate in The B.C. Masters Cycling Association activities, I hereby personally assume all risks in connection with those activities and I further agree to forever release, discharge, waive, save and hold harmless the B.C. Masters Cycling Association, Cycling B.C., the Canadian Cycling Association, the Activity Leaders, Volunteers and any Agents from any claim by me, or by my family, estate, heirs or assigns arising out of my participation in these activities. This includes, but is not limited to, waiving any and all rights, demands, or claims for damages and causes for suits or actions known or unknown, and further includes but is not limited to medical expenses or other expenses in the event of accident, illness, other incapacity, death or damage to property. I further state than I (rider, parent or guardian) am of lawful age and legally competent to sign this Affirmation, Waiver and Release. I understand that the terms of this document are contractual and not a mere recital and I have signed this document as my own free act. I attest and verify that I have full knowledge of the risks involved in participation of Club activities. I agree to obey the rules of the road and act in a courteous manner towards other road users in a spirit of good will and co-operation. I understand I need my own liability coverage (Cycling BC Race License). I have fully informed myself of the contents of this Affirmation, Waiver, Release by reading it before signing below.
Signature_______________________________________ Date____________________
Signature of parent or guardian: _________________________Date __________________ (if under 19 years of age at time of signing Waiver)
_________________________________________________________________________
(For office use only) Citizen Race License attached O
RACE NUMBER ______________ Paid By: ___________
