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United
States Adventure Racing Association
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At event, this form is needed in
duplicate (two copies for each Team member).
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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
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Amount Paid:
$__________ |
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Return to BEAR Info Page |
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