Home             About Us             Membership Form          2012 Rally

NOTE: This online form will NOT work if you are using an internet email account such as  Hotmail or Gmail.

Please send an email to BikeClub@shaw.ca requesting this form via email so you can fill it out electronically that way.

By submitting an application for membership, you agree to the Release & Hold Agreement at the end of the form below.

Application for Membership in:

SUPERIOR RIDERS

 
Today's Date:   dd-mmm-yyyy (e.g. 01-Apr-2011)
Rider's Full Name:
Rider's Date of Birth:   dd-mmm-yyyy (e.g. 05-Jan-1950)
Co-Rider's Full Name:
Co-Rider's Date of Birth:   dd-mmm-yyyy (e.g. 05-Jan-1950)
Mailing Address (Street):
City:
Province / State:
Postal / Zip Code:
Phone:
Cell Phone:
Email Address:
  Year Make Model
Bike # 1:
Bike # 2:
Bike # 3:

Release and Hold Harmless Agreement

I understand that Superior Riders cannot assume responsibility for any aspect of my safety.

 I understand that my participation in any club activity is strictly voluntary.

I release and hold harmless Superior Riders or any of its members from any injury or loss to my person or property.

    

Click on the Accept & Send button above to agree to the Release and Hold Agreement (Waiver)  and submit this form information via email.  This  will open your email program and start a new message that is ready to send.  Simply click on the email's Send button.