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United States
Adventure Racing Association
At event, this form is needed in triplicate (three
copies).
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Membership Application -- Print and mail this form (Or Event will mail to
USARA)
| NAME |
_________________________________ |
AGE |
________ |
|
| ADDRESS |
_________________________________ |
GENDER |
__________ |
|
| CITY |
_________________________________ |
STATE ________ ZIP_________ |
| PHONE
(h) |
___________________________ |
PHONE (w) |
____________________ |
| E-MAIL |
_________________________________ |
|
|
ACKNOWLEDGMENT OF RISK, RELEASE
OF LIABILITY AND INDEMNIFICATION AGREEMENT |
This
Agreement is given by the undersigned Applicant for the benefit of
United States Adventure Racing Association ("USARA"), and
its respective divisions and associations, employees, agents,
members, sponsors, promoters and affiliates (collectively "Releasees").
I acknowledge that adventure racing is an inherently dangerous sport
in which I participate my own risk and that the USARA and its
associations are non-profit corporations formed to advance the sport
of adventure racing, the efforts of which directly benefit me. In
consideration of and as a condition of my membership in and the
issuance of a license to me by USARA, I individually and on behalf
of my heirs, executors, administrators, legal representatives,
successors and assigns, release and forever discharge, hold
harmless, indemnify, including as to attorney fees, and promise not
to sue Releasees on, from or against, and waive, any claims,
damages, expenses or demands arising directly or indirectly from or
attributable in any way to the negligence, action or failure to act
of any Releasees in connection with the sponsorship, organization or
execution of any adventure racing or sporting event, including
travel to and from such event, in which I may participate as a
racer, rider, team member, spectator or in any other manner. Every
term and provision in this agreement is intended to be severable. If
any one or more of them is found to be unenforceable or invalid,
that shall not affect the other terms and provisions, which shall
remain binding and enforceable.
I currently have no known physical or mental condition that would
impair my capability and am fit to fully participate in adventure
racing. |
| PRINTED
NAME OF APPLICANT __________________________________________ |
| SIGNATURE
X _________________________________________ |
Dated: |
_________________________ |
| Signature
of Applicant (All applicants must sign in ink.) |
|
FOR MINORS:
PARENT OR GUARDIAN MUST COMPLETE THE FOLLOWING |
| I, as
parent or guardian of the Applicant, represent to the Releases that
the facts herein concerning my child or ward are true. I give my
permission for my child or ward to enter any adventure race or event
permitted by USARA or its associations during the period of the
license applied for, and further, in consideration of the granting
of such license, agree, individually and on behalf of my child or
ward, to the terms of the above agreement. |
| __________________________________________PRINTED
NAME OF PARENT OR GUARDIAN |
| X_______________________________________ |
Dated: |
_________________________ |
Signature
of Parent or Guardian
|
| Please
check one: |
| 1
Year USARA License with subscription to Adventure World Magazine
$35.00 |
___________ |
| Single
Event USARA Race License $8.00 (Pay at Event) |
___________ |
|
Mail completed application and fees (Check or Money Order payable
to USARA) to the address below:
Performance MultiSports
Jakson Badenhoop, Director
365 Charlemagne Circle
Ponte Vedra Beach, Florida 32082
|
Amount Paid:
$__________ |
|
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Return to Performance
GATOR entry page |
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|
AR Waiver