San Fernando Valley Bicycle Club
Membership Application

Name:	______________________________________________
Address:	______________________________________________
City/State/Zip:	______________________________________________
Phone:	______________________________________________
Email:	______________________________________________

Membership dues for 12 months: Individual $18.00 plus $1.00 for each individual at the same address.
Make checks payable to: San Fernando Valley Bicycle Club, Inc.
Mail to:
SFVBC - Membership
P.O. Box 462
Woodland Hills, CA 91365-0462
(818) 347-6148

List other members’ names:

____________________________________

Receive email announcements from SFVBC?	Yes____No____
List phone number in the SFVBC Members Only Roster?	Yes____No____
List address in the SFVBC Members Only Roster?	Yes____No____

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY "AGREEMENT".
In consideration of being permitted to participate in any way in SFVBC sponsored bicycling activities ("Activity") I for myself, my personal representatives, assigns, heirs, and next of kin:
1. Acknowledge, agree and represent that I understand the nature of bicycling activities and that I am qualified to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2. Fully understand that: (a) bicycling activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis, and death ("Risks"); (b) these Risks and dangers may be caused by my own actions, or inaction, the actions or inaction of other participating in the Activity, the condition in which the Activity takes place, or the negligence of the releases named below; (c) there may be other risks and 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 all responsibility for losses, costs, and damages I incur as a result of my participation in the Activity.
3. Hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless the San Fernando Valley Bicycle Club, the League of American Wheelmen ("LAW"), their respective administrators, directors, agents and employees, other participants, any sponsors, advertisers, and if applicable owners and lease holders of premises on which the Activity takes place (each considered one of the releases herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise, including negligent rescue operations.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intent it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

Participant’s signature: __________________________________ Date: ___________

Participant’s signature: __________________________________ Date: ___________