Gravity Canterbury
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Membership Form

 

MEMBERSHIP APPLICATION

2017/18 Gravity Canterbury Club Membership Application
To take part in our club events you must be a member of Gravity Canterbury or another MTBNZ-affiliated club. Your membership lasts for one season, so it needs to be renewed each year. Please complete this form for your first club event for the season.

A form/fee is not required from members of other clubs who race in our events but you need to verify your out-of-town club membership and sign an on-the-day consent to abide by our race rules.

 
Name *
Name
Home Address *
Home Address
Date of Birth *
Date of Birth
(Under 18 riders at time of registering must get a parent/caregiver to fill in the consent section below)
Please read and sign the following. A parent/caregiver must sign on behalf of riders aged under 18 years. I agree and understand the following: 1. I participate in events organised by the club entirely at own risk. I have considered and understood the nature of such events. I am sufficiently responsible and be responsible for my own safety. 2. I know that events may take place on public roads and assume responsibility for my own safety in relation to other traffic and observe the laws relating to road traffic. 3. I agree that while participating in any event I do so without any liability whatsoever on the part of the club, committee, event organiser, or any club or organisation affiliated thereto or its officials or members, in respect of any injury, loss or damage suffered by me due to my own actions. 4. I confirm that I have no disability or medical condition, physical or mental, which could affect my ability to ride safely. I understand that I must notify the secretary of the club at once if I become subject to a disability or medical condition, physical or mental, which could affect my ability to ride safely. 5. I consent to any emergency treatment necessary during the course of an event. I authorise the event organiser(s) to sign on my behalf any consent required by the hospital authorities, in the case where a surgical operation or serum injection may be deemed necessary, providing that the delay involved to obtain my signature may be considered in the opinion of a doctor or surgeon concerned, likely to endanger my health or safety. 6. I acknowledge that my bicycle and personal belongings are transported at my own risk and it is my responsibility to ensure that my bicycle is secured before transport commences.
Date *
Date
Season Membership Fee *
$20 per rider
Medical Information
This information is required so that timely and appropriate medical care can be provided in the event of an accident. The information will remain confidential, only Gravity and race organisers, ambulance and hospital staff will have access to it. Tick below if you have any of these medical conditions listed and provide any details that first aid or emergency services need to know about.
Please provide details if you ticked any of the above. Thank you.
Please volunteer to help
Our races can only take place with an enormous amount of volunteer help. We ask ALL members to volunteer themselves, or supply a volunteer, for at least one event each season. No volunteers = no events. Please contact me/my supporter about helping with:
Volunteer's Name
Volunteer's Name