Online Event Registration Western Cycle XC8 2012 Early Bird Registration closes July 18th, 2012 (10pm) Regular Registration closes September 5th, 2012 (10pm) Name: Team Name (if applicable): Please ensure your Team Name is the same for all members Phone Number: Address: City: Province / State: Postal Code: Email: Race License # (if applicable): Bike Club: I Do Not Require Require a One-Day Race License ($20 fee) For insurance purposes, you must meet ONE of the following requirements: Be a member of a provincial bike club affiliated with the CCA Have a valid race license Purchase a one-day race license for $20. Gender: Male Female Date of Birth: (DD/MM/YYYY) Category: Solo (Male or Female) Team of 2 (Open) Team of 2 (Female) Team of 4 Class: Mountain Bike Singlespeed Bike Classes are NOT separate divisions, they race with the regular Categories indicated. Additional Prizes offered for SS. Camping: Camping is provided for all volunteers and racers as well as their families, friends, and support crew. Please indicate if you will be camping on site at XC8. RVs (no hookups) and tents acceptable. Friday Night Saturday Night My Meal: Please choose the type of Dinner meal you want (Regular or Vegetarian) Regular Vegetarian Extra Meals: A Catered Dinner is provided for all participants and volunteers. If you would like to purchase additional meals for family, friends, support crew, etc. please indicate how many meals you would like to add. Price is $20 per extra meal. x Regular Meal x Vegetarian Meal Event T-shirts: All proceeds of our "Official Event T-shirts" support our club events and commitments to amateur cycling for all ages. Event T-shirts are $25 each. x Small x Medium x Large x Extra Large I understand and agree the waiver and terms below I understand and agree that my participation in above noted event organized, operated, conducted and/or sanctioned by the Canadian Cycling Association and/or Provincial Associations and Various CCA Clubs and Members registered with CCA is conditional upon my execution of this document. I am aware that cycling, and in particular competitive cycling and endurance racing, involves the possibility of injury or death. I accept these risks, and all others arising from this events, even if arising from the negligence, gross negligence or negligent rescue by those associated in any way with the Canadian Cycling Association and/or Provincial Associations and Various CCA Clubs event I may be involved in, the venues at which this events and programs takes place or by those organizing, officiating, or participating in this event and program, including their respective officers, directors, employees, agents, servants, volunteers and representatives (the “Releasees”).I understand that all applicable rules for participation must be followed and that SOLE RESPONSIBILITY FOR MY PERSONAL SAFETY REMAINS WITH ME, including my physical and emotional preparation and fitness to participate in all events and programs throughout the year. I undertake and agree to remove myself from participation if I sense or observe any unusual hazard or unsafe condition, or if, at any time, at any event or program, I feel unable or unfit to safety continue for any reason. I give, a FULL RELEASE AND WAIVER OF LIABILITY AND ALL CLAIMS that I have, or may have in the future, against Canadian Cycling Association, and all other Releasees from all liability for any loss damage, injury or expense that I may suffer as a result of my participation in any part or parts of the event or program or my presence at any venue at which they may take place, due to any cause whatsoever including the forms of negligence set forth in paragraph 2 above or from any breach of contract or statutory duty or other duty of care including any duty of care owed under the relevant Occupier’s Liability Act, on the part of the Releasees. I AGREE NOT TO SUE and I further agree TO INDEMNIFY AND SAVE HARMLESS the Releasees from all expenses, fees, liability or damage award or cost of any type whatsoever arising from my participation in these events or programs. I HAVE READ AND UNDERSTOOD THIS WAIVER, RELEASE AND INDEMNITY. I am aware that by signing this agreement I am waiving substantial legal rights (on my behalf and on behalf of my heirs, executors, administrators and next of kin), including the giving up of my right to sue. Signature (Name): Date: I understand and agree the waiver and terms below PARENTAL CONSENT FOR MINOR PARTICIPANT and INDEMNITY AGREEMENT I have read and understood the above waiver, release and indemnity, and have discussed the same with the minor person signing above. I am satisfied the said minor understands the waiver and release and his/her obligations as set out. In consideration of the participation of my minor child/ward I too agree to waive, release and indemnify the Releasees in the terms set out above. I am aware that by signing this agreement I am waiving substantial legal rights, which my minor child/ward and I, our respective heirs, executors, administrators and next of kin may have against the Releasees. Signature (Parent Name): Date: