Membership Application and Renewal I,(Your full name)(hereinafter ”Member”) wish to apply for club membership to SORELLA FORTE (hereinafter “SORELLA FORTE” or “CLUB”) for the 2019 season. Club dues are $95.00 for NEW members and include a short sleeve jersey. Renewal fees for existing members are $35. All members must complete the following application each year. Once completed, you will then be directed to our online payment page. In consideration of the acceptance of my application for membership I hereby freely agree to and make the following contractual representations and agreements. In order to maintain a professional image for the benefit of the Club, its sponsor’s and myself, I agree to wear team issue clothing at all races and club training rides. I also agree to wear a USA Cycling approved helmet at all times I am riding a bicycle, whether racing or training. I understand that the benefits associated with being a member of SORELLA FORTE are intended solely for SORELLA FORTE members and I agree not to use sponsorship benefits and products as sale items for personal monetary gain. I understand that as a member of SORELLA FORTE I must race in accordance with the USA Cycling./OBRA rules and the SORELLA FORTE bylaws. Further, I understand that it is important to maintain my composure and project a professional image in public for the good of the club and its sponsors. I understand and agree that before I begin any exercise program I should consult a physician and have a physical examination. I understand and agree that should SORELLA FORTE, its members, Board of Directors, Officers, employees or agents provide me with recommendations, instructions and advice, said advice is in no way intended to be construed as medical advice and is offered for informational purposes only. I further understand that SORELLA FORTE, its members, Board of Directors, Officers, employees or agents make no warranties or representations regarding any advice given. I have made no misrepresentation to SORELLA FORTE, its members, Board of Directors, Officers, employees or agents in regard to my age or physical condition. I understand that SORELLA FORTE, its members, Board of Directors, Officers, employees or agents cannot confirm certain representations made by me, including but not limited to representations as to my diet, physical condition or workout regime. I acknowledge that bicycling is an inherently dangerous sport and fully realize the dangers of participating in a bicycle club and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation, the following: the danger of collision with pedestrians, vehicles, other riders, and fixed or moving objects; the dangers arising from surface hazards, equipment failure, inadequate safety equipment, weather conditions, and MEMBER’S OWN NEGLIGENCE; and the possibility of property loss, and serious physical and/or mental trauma or injury associated with bicycling and related activities. For myself, my heirs, executors, administers, legal representatives, assignees, and successors in interest I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMELESS, PROMISE NOT TO SUE AND INDEMNIFY SORELLA FORTE, members of the SORELLA FORTE Board of Directors, the sponsors of this Club, Club members, Club Officers, other athletes and ride participants FROM ANY and all rights and CLAIMS INCLUDING BUT NOT LIMITED TO CLAIMS FOR BREACH OF CONTRACT AND CLAIMS ARISING FROM THE RELEASED PARTIES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of my participation in or association with the Club, or travel to or return from Club events. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during Club events. I have no physical or medical condition which to my knowledge would endanger others or myself if I participate in this Club, or would interfere with my ability to participate in this Club. By checking the box below, I hereby certify that I have read this application and liability release agreement and I understand its content. I affirm that I have the authority to enter into this agreement on behalf of the minor participant I am representing and I agree to be bound by the terms of this agreement.Accept Agreement*YesSelect One:*New MemberRenewalNew Juniors MemberJuniors RenewalName First Name Last Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Phone*Is this a mobile phone?*YesNoEmail Address* Date of Birth* Date Format: MM slash DD slash YYYY Emergency Contact* First Last Emergency Contact Phone*OBRA Racing Categories (optional):Total $0.00 Payment typePay using PayPalPay by CheckPlease mail your payment to: Susan Koonce 913 SE Lexington St. Portland, OR 97202That's it! Please submit this form and continue to process payment.