BICYCLE CLUB OF IRVINE Membership Form (Renewing members need no form*)
To join the BCI, complete this form (please print) and return it with your initial dues.
The current dues rates. Please sign up only one member per form

Name : _____________________________ Birth Date: ____/____/____ Adult    Minor under 18

Address: ___________________________ City : ____________________ ST:_____ Zip:______________

Home Phone: ____/____________ Work Phone: ____/____________ E-Mail: ________________________
Are you a past / current BCI member? No; I'm New Yes; BCI#: ________
(NewAddress)*
A Membership Roster is distributed to members, listing name, address & home phone.
Do you want to be listed in the next roster? Sure! NO; DO NOT list me in the roster.
The BCI also provides or sells our mailing list to various groups, businesses & ride promoters.
Do you want to receive this mail? Sure!     NO; DO NOT give my address to others.
How did you hear about the club?
________________________________________________________
Give the name of the Member who referred you to the Club, their membership will be extended as a Thank You...

What kind of bike(s) do you ride/own?
Road     Touring    Comfort (Commuter/Hybrid)    ATB (All-Terrain/Mountain)
Tandem  Unique (Recumbant / Hand driven / 3 wheeled / Big Wheeler / Other:______________ )

How far do you currently enjoy riding? (in miles)
SHORT (20 or less)   MEDIUM (25-30)   LONG (over 40)   CENTURIES (100+miles)


STANDARD BICYCLIST'S RELEASE FORM - REQUIRED FOR MEMBERSHIP
READ CAREFULLY: THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS

   In consideration of the acceptance of my application for membership and participation in the Bicycle Club
of Irvine (BCI), I hereby waive, release and discharge any and all claims for damages for death, personal injury
or property damage which I may have,  or which may hereafter accrue to me,  as a result of my participation
with the BCI.  This release is intended to discharge in advance the promoters, the sponsors, the Bicycle Club
of Irvine (BCI),  and any involved municipalities or other public entities (and their respective officers, agents
and employees ),  from and against  any and all liability  arising out of  or connected  in any way  with  my
participation in BCI events, even though that liability may arise out of negligence or carelessness on the part
of the persons or entities mentioned above, including but not limited to any negligence or carelessness related
to the design of the route, obstacles on the route, or the marshaling of the public on the route.
   I further understand that serious accidents occasionally occur during bicycle rides; and that participants in
rides occasionally sustain  mortal and serious personal injuries and  / or  property damage,  as a consequence
thereof. Knowing the risks of bicycle riding, nevertheless, I hereby agree to assume those risks and to release
and hold harmless  all of the persons or entities mentioned above who  ( through negligence or carelessness )
might otherwise be liable to me (or my heirs or assigns) for damages.  It is binding on my heirs and assigns.
I agree  to accept and abide by the rules of the road  and vehicle laws.  I understand  that the BCI  strongly
encourages the wearing of ANSI/SNELL approved helmets for all bicycle riders.
   I do hereby consent to the treatment of myself (or of my minor child), to any and all medical care deemed
necessary by a qualified physician and  to pay any and all medical costs  incurred as a result of said treatment.

I hereby acknowledge that I have read the foregoing and understand the contents thereof.

 
_________________________
  
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 Signature of Participant  Signature of Parent/Guardian if under 18  Date Signed/Joined

Please send this form (with your dues made payable to the Bicycle Club of Irvine) to:
Data Management Services · 405 E Wilson Ave · Orange CA 92867-4832
e-form Revised 08/09/02      Link back to BikeIrvine.org      Link to Current Dues 

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