Instructions:

1. Complete the membership application and liability waiver form. Be sure to sign & date the liability waiver form. Click here to print the liability waiver form.
2. Print 2 copies of each form. Keep one copy for your records and mail the completed membership & signed dated liability waiver form to:
   
   Sierra Express Bicycle Club
   228 Commercial Street
   PMB # 163
   Nevada City, CA 95959
3. Be sure and enclose your check in the amount of $12.00 made payable to: Sierra Express Bicycle Club.

Type:*	New:   Renewal:   Revision:
First Name:*
Last Name:*
Telephone:*
Email Address:*
Email Address Not for List Server:
Your email address will be subscribed to the club email distribution listserve unless you check "not for listserver." The listserve is the best method of receiving information on club rides, events, business, and obtaining the current member roster, because there is no paper newsletter. Your email address will not be published on any web site by SEBC, nor will it be shared by SEBC with any other organization or business.
Postal Address 1:*
Postal Address 2:
City:*
State:*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:*
Personal Information Not For Roster:
**Information you submit in the above section (s) is meant for exclusive use of club administrators / members. It is not intended to be published on any other web site, or shared with any other business by SEBC members or administration. However, this does not imply or guarantee any absolute right to privacy as any information provided on the club roster is available to our membership by request. Please check” not for roster” if you do not wish the above information to be provided to our club members.
Remittance Dues:*	Calendar year dues = $12. Due by January 31.
Remittance Method:*	Check:   Money Order:   None:
Check Number:*
Notes:	Notes
Acknowledgement:	RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT IN CONSIDERATION of being permitted to participate in any way in the Sierra Express Bicycle Club (“CLUB”) 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 bicycling activities 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) 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 or that of the minor in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the Club, the LAB, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessers 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 AGREEING TO IT AND HAVE AGREED TO 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.
	I have read and do hearby agree to the above terms and conditions.
Required Fields*