Shoals Cycling Club

Membership Application

2008

Name_____________________________________________ Phone (H) ____________________

Address___________________________________________ Phone (W) ____________________

City ____________________________________ State _____________ Zip __________________

E-mail _________________________________________ Date of Birth _____/_____/__________

Cell Phone ___________________

Permission to publish information in club directory: □ Yes □ No

SCC memberships expire at the end of each year. Mail this application with a check / money order made out to:

Shoals Cycling Club

P.O. Box 3851

Muscle Shoals, AL 35661

Membership Type

□ Individual $ 25.00

□ Family $ 25.00 plus $5 for each additional family member (Total Amount: $__________ )

Release of Responsibility: The person signing this document certifies that he/she has examined the information on this release form and membership application and that all information is complete, true, and correct. For the sole consideration of being allowed to participate in Shoals Cycling Club (SCC) activities, the undersigned hereby releases and forever discharges SCC members, agents, officers, volunteers, personal representatives, their heirs, successors and all other persons, firms, and corporations liable or who might have claimed to be liable (all and each "Released Person") from any and all claims, demands, damages, actions, causes of action or suits of any kind and nature whatsoever, and particularly on account of all future injuries both to the person and property which may have resulted, or may in the future, develop from participation in or traveling to and from SCC activities or SCC sponsored events. I fully realize, acknowledge, and assume the risks of the hazardous nature and dangers of participating in any club activities, including by way of example and not limitation, the following: collisions with pedestrians, vehicles, other riders, and fixed or moving objects; safety hazards, equipment failure, inadequate safety equipment, and weather conditions; and the possibility of serious physical injury associated with cycling (each and all of which shall be referred to as 'Injury').

This release has been completely read by or to the undersigned and the terms hereof are fully understood and voluntarily accepted for the purpose of releasing each Released Person from any and all claims, disputed or otherwise on account of any injury.

Member’s Signature: ______________________________________________Date:________________

(Guardian, if under 19) ____________________________________________ Date:________________