Membership Form

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HANCOCK HANDLEBARS BICYCLE CLUB

Membership Application, Affiliation & Renewal Form

Fees:  Youth (under 16) $5.00 - Single $12.00 - Family $18.00

The Hancock Horizontal Hundred s an organized tour put on by the Handlebars each September.

It is the primary fundraising mechanism for the Handlebars.  We need to know if you can volunteer a portion of your time to ensure the success of this event.  Please mark "YES" or "NO" below:

YES ____

NO   ____  

League of American Wheelmen (LAW) Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement

In consideration of being permitted to participate in any way in Hancock Handlebars ("Club") sponsored 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 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 conditions in which the Activity takes place, or the negligence of the "Released" 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 and covenant not to sue the Club, the LAW, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and leasors of 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 may incur as the result of such claim. 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.

Participant’s signature (if over 18).  Parent’s signature (if under 18)

Please make check or money order payable to “Hancock Handlebars Bicycle Club”.  Mail payment and completed application to:  Hancock Handlebars Bicycle Club, P.O. Box 232, Findlay OH 45839.  Your application will be processed quickly and you will be added to the mailing/email lists.