2014/15 Gravity Canterbury Club Membership Application

Note: This form must also be completed by members of other clubs who enter Gravity events on an on-the-day basis.
To race in any of our club events you must be a member of Gravity Canterbury or another club affiliated to BikeNZ. Your
membership fee helps fund club overheads and administration, and some of the fee goes towards supporting Mountain Bike NZ
promote mountain biking and rider development. Thanks for your support.

Full name
Home address
Cell phone

Home

Email address

(under 18 riders must get a parent/caregiver to fill in the

consent section below)

Date of Birth

Consent required
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.

Signed (Rider OR Parent/Guardian) _______________________________________________________ Date: _____/______/______

Paid
Cash
Cheque
Membership fee for the season

$20 per rider

I am a paid-up member of another BikeNZ-affiliated club
Please specify ________________________________________

Exempt

Volunteer help, please

Downhill 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:

Marshalling
Van driving (25+)
Race timing (spotting numbers, herding riders)
Other please specify (e.g. prizes, BBQ cook, Food for volunteers)
Volunteers name:___________________________________________Phone: _____________________________________

PLEASE BRING THIS FORM AND YOUR $20 TO THE FIRST RACE YOU ENTER FOR THE 2014/SEASON.