Richmond Area Bicycling Association, Inc. Membership Application …

 Richmond Area Bicycling Association, Inc.
 Membership Application
 Please print out this form, complete and sign it, make check payable to RABA and mail to:
 RABA Treasurer
 P.O. Box 6565
 Ashland, VA 23005


 Please allow 4-6 weeks for processing.

 NOTE: Waiver of Liability must be signed and dated (on page 2) in order to activate membership.

The membership term begins January 1 and ends December 31 of each year.

For renewals or for new members joining between January 1 and June 30:
 $20 Annual Dues for Individual (18 years of age or older)
 $25 Annual Dues for Family (1 or 2 adults and all dependents under 18)

For new members joining between July 1 and December 31:
 $10 Annual Dues for Individual (18 years of age or older)
 $12.50 Annual Dues for Family (1 or 2 adults and all dependents under 18)

 [ ] New Member [ ] Renewal [ ] Individual [ ] Family
 Name1________________________________________ Age:____________
 Name2_________________________________________Age:____________
 Children:_____________________________________________________
 Address:______________________________________________________
 City:________________________________ State:_____ ZIP:________
 Home Phone:__________________________
 Work Phone:__________________________
 Email address:________________________________________________

 LEAGUE OF AMERICAN BICYCLISTS ("LAB") RELEASE AND WAIVER OF LIABILITY,
 ASSUMPTION OF RISK AND INDEMNITY AGREEMENT ("AGREEMENT")
 IN CONSIDERATION of being permitted to participate in any way in the Richmond Area Bicycling
 Association, Inc. ("Club") 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, in good health, and in proper physical condition 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 inactions, the actions
 or inactions of others participating in the Activity, the condition in which the Activity takes place, or
 THE NEGLIGENCE OF THE "RELEASEES" 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 or that of the minor in the
 Activity.
3. HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE the CLUB, the LAB, their
respective administrators, directors, agents, officers, members, volunteers, and employees, other
participants, any sponsors, advertisers, and if applicable, owners and lessors of the premises on
which the Activity takes place, (each considered one of the "RELEASEES" 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 "
RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I
FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF
RISK AND INDEMNITY AGREEMENT, I, or anyone on my behalf, makes a claim against any of
the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES
from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may occur as
a result of this claim.

4. I CONSENT TO EMERGENCY MEDICAL TREATMENT IF I AM INJURED.
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 intend 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.

Printed Name of the Participant:_________________________________________
Print Address:______________________________________________________
Phone:______________________
Participant's Signature (only if age 18 or older):
x____________________________________________I HAVE READ THIS RELEASE
Date:_________________________

And I, the Minor's Parent and/or Legal Guardian, understand the nature of bicycling activities and
the minor's experience and capabilities and believe the Minor to be qualified, in good health, and in
proper physical condition to participate in such Activity. I hereby release, discharge, covenant not to
sue and agree to indemnify and save and hold harmless each of the whole or in part by the
negligence of the "Releasees" or otherwise, including negligent rescue operations and further agree
that if, despite this release, I, the Minor, or anyone on the Minor's behalf makes a claim against any
of the Releasees named above, I will indemnify, save and hold harmless each of the Releasees
from any litigation expenses, attorney fees, loss, liability, damage or cost any may incur as the
result of any such claim.

Printed Name of Parent/Guardian:________________________________
Print Address:_________________________________________________________
Phone:___________________________
Parent/Guardian Signature (required only if participant is under the age of 18):
x__________________________________________I HAVE READ THIS RELEASE
Date:________________________