2012 Team Registration Info

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Westwood Velo 2012 Club Membership Fees

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WESTWOOD VELO - BICYCLE CLUB
Membership Application
Release of Liability and Indemnification Agreement
READ BEFORE SIGNING
WESTWOOD VELO INC. (WV) is a not for profit organization - for bicycle enthusiasts of all ages. By
riding, joining or involving yourself in WV, its training or racing events, or any other activities, you hereby
agree to the terms and conditions noted below as a condition precedent to your involvement with the Club.
This Agreement is given by the undersigned Applicant for the benefit of the WV, members, officers,
trustees, sponsors, promoters, and volunteers (collectively "Releasees").
In consideration of being allowed to participate in any way in Westwood Velo, its related events and
activities, I, ( ) , the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce
this risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility
for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If,
however, I observe any unusual significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention of the Company immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND FOREVER DISCHARGE, INDEMNIFY INCLUDING AS TO ATTORNEYS FEES,
PROMISE NOT TO SUE AND HOLD HARMLESS Westwood Velo Inc. their officers, officials, agents
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners
and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL
INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or
participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.
This agreement may not be modified orally, and a waiver of any provision shall not be construed as a
modification of any other provision herein or as consent to any other provision herein or as consent to any
subsequent waiver or modification.
I currently have no known physical or mental condition that would impair my capability to fully participate
in cycling activities.
I hereby understand that my membership in the WV is conditioned on my being a "Member in Good
Standing".. To be considered a Member in Good standing with the WV, I will do the following:
a. Sign, complete and return original copies of this Release of Liability and Indemnification;
b. Submit all annual membership dues to WV as directed within a reasonable time frame;
c. Volunteer and support at minimum one (1) WV race event during the Calendar year;
d. Adhere to all USCF Athlete code of ethics
e. If you are unable to support an event, you must speak to Alex Belgiovine (alex@sbcpas.com) in advance to
arrange for some other way to contribute to the Club or your membership shall be terminated. If your
membership is terminated, no dues will be refunded.

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I HAVE READ THIS RELEASE OF LIABILITY(PAGE1) AND ASSUMPTION OF RISK
AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT.
Signature: ______________________________________ Dated:__________________
Printed Last Name: ___________________________ First Name:_____________ MI ___
Date of Birth: ___/___/___ (if Under 18 please has Parent Guardian sign on Page 3)
Address: ____________________________________
____________________________________
__________________ State___ Zip _______
USCF License (Y/N) If Yes, License # _______________ Category __________
Norba License (Y/N) If Yes, License # _______________ Category __________
Phone: (____) ____-_______ E-Mail: _______________________________________
In Case of Emergency:
Contact: ______________________ Relationship:_________________
Phone: (____) ____-_______
Attention: Westwood Velo Bicycle Club Members
The following two items are conditions to your membership in WV:
1. Membership dues:
Please note the dues for the 2012 season are $50. Late Payment - If paid after March 1 2012, WV may do
either of
a) Deny your membership in the club, and remove you from the USCF WV database
b) Assess an additional $50 late fee;
Please register via bikereg.com NO CHECKS WILL BE ACCEPTED
2. Mandatory Marshalling/Support of no less than one (1) Club Event.
As part of the privilege of membership, each racing member is obliged to serve as marshal at one of the club
events listed below. You must select a Preferred Event which you would like to support. Approximate dates
are provided. The WVBC will thereafter advise the final support roster and which event to which you were
assigned. Failure to attend or support the event to which you are assigned, without approval and exemption
will result in your membership being terminated immediately. These events are the life blood of our Club
and we believe we should all be able to provide one day to our club. If you are unable to attend any of these
events, you must speak to Nick Alutin (nalutin@gmail.com) in advance to arrange for some other way to
contribute to the Club or your membership shall be terminated. If your membership is terminated, no dues
will be refunded..
Silvermine/Longmeadow TT (approximately Early August) ___________
Cyclocross (approximately Early Oct )______________
Rochleigh Critieum (approximately Thursdays late May through late August )____________

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RELEASE BY PARENT OR GUARDIAN
I, as parent or guardian of the Applicant, represent to the Releases that the facts herein concerning
my child or ward are true. I give my permission for my child or ward to participate in any club
activities during the period of membership in the WV, and further, in consideration of such
membership, agree, individually and on behalf of my child or ward, to the terms of the above
Agreement.
Signature of Parent or Guardian____________________________________
Dated:__________________
***SUBMITTING THE WAIVER AND DUES*****
Membership Dues: Please register via bikereg.com using the following link:
http://www.bikereg.com/events/ConfList.asp?EventID=7585.
All applicants must sign the release and indemnification agreement and Register via Bikereg.com. Return the completed
release to

Nick Alutin c/o Westwood Cycle

182 3rd Ave Westwood NJ 07675

For more info Please call Nick 201-803-2463 or

Mark 201-664-1688