P.O. Box 205, Manteca CA 95336

Name (s): ________________________________ Age(s): _______________

Address: _________________________________ City/State/Zip:__________

EMAIL:__________________________ Phone:________________________

Emergency Contact (Person & Phone): ___________________________

Annual membership fee is $12 per individual or $15 per family membership are due on May 1st.

For myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest (collectively referred to as "successor" in this document), I RELEASE, FOREVER DISCHARGE AND AGREE NOT TO SUE the Manteca Bicycle Club (MBC), its members, sponsors, promoters, and promoting organizations, other riders, and property owners, law enforcement agencies, public entitles and special districts (and their respective agents, officials, and employees) through or by which cycling events and activities are conducted, from any and all liability, claims, loss, cost or expense, including but not limited to, those arising from property damage or loss, injury to my body, mental trauma, or death, and to waive any such claims against any such persons or organizations, arising directly or indirectly from, or attributable in any legal way to, any negligence or other action or omission to act of any such persons or organizations, in connection with sponsorship, organization or conduct of any bicycle riding or sporting event or activity, including travel to or from such event or activity, in which I may participate as a rider, club or team member, spectator, official or volunteer.

I agree it is my sole responsibility to be familiar with applicable rules or special regulations for MBC cycling events or activities. I must continually ride so as to neither endanger others or myself. I accept responsibility for the condition and adequacy of my riding equipment. I will ride wearing a helmet, and assume all responsibility and liability for the selection of such a helmet. I have no physical or medical condition, which to my knowledge, would endanger others or myself if I participate in bicycling events.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE MANTECA BICYCLE CLUB AND SIGN IT OF MY OWN FREE WILL.

SIGNED:_______________________________________ DATE:_______