Mail to: . \ aoe

4 ASSOCIATION CANADA
P.O. BOX 346.
SURREY, B.C. V3T SVE

A NON-PROFIT SOCIETY FOR THE BENEFIT OF THE SPORT

| Novice or Expert License $20.00 per year |

APPLICATION FOR RACING LICENSE AND WAIVER OF ALL CLAIMS
(Please type or print)
CORENEWAL (NEW MEMBER (CJNOVICE [CJ EXPERT (C)RBEGINNER

(No fee necessary)
Plate No. (If renewal)

NAME DATE
ADORESS CIMALE (FEMALE

city _. POSTAL CODE

AGE... BIRTH DATE TELEPHONE

SPONSOR
BIKE OTHER 8MX ASSOCIATION MEMBERSHIPS

WAIVER OF ALL CLAIMS

We, the undersigned, for ourselves and for our heirs, personal representatives and assigns, do hereby release and forever
discharge the property owners and any other person, firm, association or corporation from any and ail claims, demands,
Gamages, costs, expenses, loss of service, actions arising from any act or occurance, and PARTICULARLY ON ACCOUNT
OF ALL PERSONAL INJURY DISABILITY, PROPERTY DAMAGE, LOSS OF ANY KIND THAT | MAY hereafter _
sustain as a result of participation in any event sanctioned or sponsored by the BMXAC, including practice and training
sessions and exhibitions. . ,

| fully understand the nature of the activities | am participating in and acknowledge the hazards of said activities and
voluntarily assume the risk of injury to my person, property of the person or property of others. If any injury occurs |
give my consent for proper treatmens.

All film and photographie rights are reserved by the BMXAC,

(If particigant is under the age of 18 years, this form’ must be signed by his/her parent or quardian.)

To the best of my knowledge | beiieve the above is true and correct, | understand that if the information given with
respect to the birthdate of applicant is not correct, this application is void and applicants membership will be revoked.
A PHOTOCOPY OF APPLICANT'S SIRTH CERTIFICATE MUST. BE ENCLOSED.

Make check or money order payable to:

Signature of Agpiicant . 8MXAC
P.O. Box 346
68 Surrey, 8.C. V3T SV6

Signature of Parent or Guardian ({f aoplicant under 18 years)
BMXAC USE: License # Expiry date Plate 2

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