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BGM Sports Membership Application

 

To join the BGM Sports please print out this form, including the release, fill it out and sign the release and return with your check.

Make checks payable to BGM  Sports and mail to:

BGM Sports  1215 Del Robles Place Simi Valley  CA 93063

 

A separate signed release must be included for all family members if joining as a family.

 

Name ___________________________________________________________________________

Other names and (ages) for family memberships___________________________________________________________________

Address _____________________________________________________________________________________

City ___________________________________________________ State _______ Zip ____________

Home phone (_____) ____________________ Work phone (_____) ______________________

Email ___________@_____________________          (  ) Recreational or (  ) Racing rider

Racers only:  USCF Road category _________   USCF License No. ______________ Birth date __________
 

Annual membership fee:

Individual  (   ) (new*) $150.00    (   ) (renewal) $50       Family   (   ) (new*)  $ 200.00**      (   ) (renewal) $75.00**

*Each new member is eligible to purchase Two (2) BGM Sports jerseys for $40 each with each paid membership application.  Additional jerseys may be purchased for $65 ea. **Family memberships only apply to those family members who have signed a release, or for whom a parent or guardian has signed a release if a minor)

 

I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM RELEASING BGM SPORTS AND ITS AFFILIATES FROM LIABILITY. THIS APPLICATION AND RELEASE IS A CONTRACT WITH LEGAL CONSEQUENCES. I HAVE BEEN ADVISED TO READ IT CAREFULLY BEFORE SIGNING.

 

Please accept this as my application to join or renew my membership in BGM Sports Cycling Club.

I acknowledge that cycling is an inherently dangerous sport in which I participate at my own risk and that the BGM Sports was formed to advance the sport of cycling, the efforts of which directly benefit me. In consideration of the agreement of BGM Sports to accept me as a member, hereby on behalf of myself, my heirs, assigns and personal representatives, I release and forever discharge BGM Sports and its affiliates, its employees, officers, directors, agents, members, sponsors, promoters and affiliates from any and all liability, claim, loss, cost or expense, and waive and promise not to sue on any such claims against any such person or organization arising directly or indirectly from or attributable in any legal way to any negligence, action or omission to act of any such person or organization in connection with sponsorship, organization or execution of any bicycling ride, event or race, including travel to and from such event or as a result of renting and/or using equipment supplied or purchased, however caused, including, but not limited to product liability or the negligence of any party whether passive or active, in which I may participate as a rider, team member or spectator. I understand that the terms herein are contractual and not a mere recital, that this instrument is a legal binding document, and I have signed it of my own free act.
 

Names of Applicants (print)________________________________________________________________________

Signatures of Applicants ___________________________________________________________Date___________

 

FOR MINORS - PARENT OR GUARDIAN MUST COMPLETE THE FOLLOWING:

I, as parent or guardian of the Applicant, represent to BGM Sports that the facts herein concerning my child or ward are true. I hereby give my permission for my child or ward to participate in any bicycling ride, event or race, sponsored by BGM Sports during the period of membership applied for, and further, in consideration of the granting of such membership, agree, individually and on behalf of my child or ward, to the terms of the above Acknowledgment of Risk and Release of Liability.

Signature of Parent or Guardian X____________________________________________________Date___________

 

Up dated 1/01/11

BGM Sports
Simi Valley CA 93063
USA
E-mail: bert@bgmsports.com
Phone: 805 217 7599

BGM logo is a registered trademark of BGM Sports
1996- 2014 All Rights Reserved

 

 

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