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.
Other names and (ages) for family memberships___________________________________________________________________
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
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