EMERGENCY AND LIABILITY FORM

Here's the form that needs to be filled out by all cyclists riding in this group. Each Organizer will determine it's requirement. Copy and paste to Word, then print and give to the Organizer you bike with...we will keep track of info in a PRIVATE General file. Or, if you have the capability, print, fill in the information, scan and email to me. Contact me directly for more information. Sydnie
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LAS VEGAS MEETUP BICYCLING GROUP
EMERGENCY AND LIABILITY FORM

Full Name: ____________________________________________________

(Last/First/Miiddle) M F (circle)
Address: ______________________________________________________
(OPTIONAL: Street City State Zip)
Your Contact Phone Number: _______________________
Birth Date (OPTIONAL): ____________________________
Email Address: __________________________________________________
(OPTIONAL)

Emergency Contact: _______________________ Phone: ____________
(Required)

Types of bikes(s) you own/ride: Road____ Mountain____ Tandem____ Other______________
Your bicycling level: Beginner_________ Intermediate ___________ Advance __________
How far do you currently ride? 10-20 miles___ 20-40 miles ___ 50-60 miles __ Centuries____


RELEASE FROM LIABILITY

I acknowledge that cycling is a dangerous sport/activity in which I participate at my own risk. The Las Vegas Bicycling Meetup Group was formed to advance the causes of safe cycling, the efforts of which directly benefit myself. In consideration of the agreement of the Las Vegas Bicycling Meetup Group to issue membership to me, hereby for myself, my heirs, assigns and personal representatives, I waive release and forever discharge the Las Vegas Bicycling Meetup Group, it?s organizers, members, sponsors, and affiliates whosoever from any and all liability, claim, lost, cost or expense arising from or attributable in any legal way to an y act or omission to act, of any such person or organization, sponsorship or execution of any Las Vegas Bicycling Meetup Group workout, race, or event, including to and from said activity in which I may participate as an Las Vegas Bicycling Meetup Group member, contestant or spectator. To the best of my knowledge I have no physical condition that would interfere with my ability to participate in or attend any said event or would endanger my life thereby.

WEARING OF HELMETS ARE MANDATORY ON ALL RIDES!


Signature: ___________________________________ Date: _____________

Parent signature (if under 18): __________________________________



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Hey all!!! Thanks to one of our members, Linda, she recreated this form also on PDF. Just click on the "FILES" link and you will find it there. You have a choice of completing it either on WORD or PDF. Hope to catch you all on a ride soon!! Sydnie