central new york finger lakes
auburn, skaneateles, owasco . . .
 

Owasco Velo Club Membership Application Form


Make checks payable to Owasco Velo Club  and mail this completed form and check to:


Dean Furnia

10 Brae Ridge Rd                               Please check one:

Auburn, New York 13021                        $15 Single _________              $20 Family _________



Name ________________________________________________________________________   Birthdate  _________________________



Address ___________________________________________  City __________________________ State ______________Zip____________



Home Phone:  __________________________    Work Phone ________________________    Cell Phone ____________________________



Email Address______________________________________________________________________________________________________



USAC License #_______________________     race category  _________         Other Cycling Clubs__________________________________



If joining as a family membership, list other family members’ name and birthdate:



_____________________________________________________________________________________________________________________    __________ / __________ / ___________




_____________________________________________________________________________________________________________________    __________ / __________ / ___________




_____________________________________________________________________________________________________________________    __________ / __________ / ___________



Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement ("Agreement"):

In consideration for being permitted to be a member of the Velo Club (here to referred to as "Club") and to participate in any way in any Owasco Velo Club sponsored Activities ("Activity"), I, for myself, my personal representatives, assigns, heirs, and next of kin:


I. ACKNOWLEDGE, agree and represent that I understand the nature of Bicycling Activities and that I am qualified 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 in the Activity.


3. HEREBY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Club, its administrators, other participants, ride leaders, volunteers, agents, any sponsors, advertisers, and if applicable, owners and leasers of premises on which the Activity take 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.


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 AND 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 INV ALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.




Participant's Signature: _______________________________________________________________________________________________



I HAVE READ THIS RELEASE  _____     Printed Name________________________________________   Date _______________________




Parent / Guardian Signature: ___________________________________________________________________________________________



I HAVE READ THIS RELEASE  _____    Printed Name________________________________________   Date _______________________


If member is under 18 years of age, payment must be paid by check signed by parent or legal guardian

IF YOU DO NOT UNDERSTAND THE ABOVE MATERIAL, CONSULT YOUR ATTORNEY BEFORE SIGNING.

  Membership

download a pdf application which is fillable for your convenience prior to printing.

2016 Club Dues

$15 individual / $20 family. Please become an active member. Support the OVC.   Send in your dues today with completed OVC Application (for new members).  If you can’t afford the membership dues, or somehow object to paying, you can still be a member.  Just send in your completed application form and we’ll cover the dues. If you pay with paypal, then send in your application to Dean Furnia at the address below.


Make out check to Owasco Velo Club and mail check / application to:

Dean Furnia  10 Brae Ridge Rd    Auburn,  NY   13021 

All of your personal information including addresses, phone numbers and email addresses are strictly confidential -- never posted online or made available to third parties.

. . . pay OVC Membership with Paypal.