Seattle Int'l Randonneurs SIR MEMBERSHIP
APPLICATION
NEWSLETTERS - RIDES/BREVETS/PERMANENTS - MEMBERSHIP - GENERAL INFO - PHOTO GALLERY - LINKS - HOME
Print out, fill in the blanks and mail the application (including dues payable to Seattle International Randonneurs) to:

Eric Vigoren
1215 5th St
Bremerton, WA 98337-1213
360-405-4255
[email protected]

PDF version coming soon.

NOTES:
1. Please note information you do NOT want published in an SIR roster.
2. The SIR roster is distributed only to current members.
3. No PayPal for memberships.
4. Memberships are active for the calendar year of January to December.


SEATTLE INTERNATIONAL RANDONNEURS 2007 Application Form
___ $10.00 Membership

Personal information: (* indicates required information)

Name *: _____________________________________________________

Address *: _____________________________________________________

City *: ____________________________ State *: _____ ZIP *: ________ Country *: __________________

Phone *: ____________________ FAX: __________________________ Cell Phone:_______________________

E-mail: _____________________________________________________

Emergency Contact *:_______________________ Phone *: ______________

Randonneurs USA membership information:
Membership in RUSA (or in an organization in another country that is a direct correspondent with Audax Club Parisien) is required for SIR membership.

Please check one:

___ Current RUSA member #________

___ Member of ACP correspondent ___________________________

___ RUSA membership application or renewal attached

LEAGUE OF AMERICAN WHEELMAN d/b/a LEAUGE OF AMERICAN BICYCLISTS ("LAB") RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("AGREEMENT")

IN CONSIDERATION of being permitted to participate in any way in Seattle International Randonneurs ("Club") and Randonneurs USA ("RUSA") sponsored Bicycling 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 the activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. 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) the ACTIVITY INVOLVES 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, DISCHARGE, AND COVENANT NOT TO SUE the Club, RUSA, the LAB, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors 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 any 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.

Reminder: All riders are reminded that any failure to conduct the ride in accordance with SIR Brevet Rider Expectations, RUSA rules, applicable laws, or any special instructions or equipment requirements for this ride may result in a time penalty or disqualification.

Signature: __________________________________________ Date:__________________