From pvv@cs.washington.edu Mon Feb 10 14:52:20 1997 Received: from mx5.u.washington.edu by lists.u.washington.edu (5.65+UW96.08/UW-NDC Revision: 2.33 ) id AA18386; Mon, 10 Feb 97 14:52:19 -0800 Received: from skate.cs.washington.edu (skate.cs.washington.edu [128.95.2.44]) by mx5.u.washington.edu (8.8.4+UW96.12/8.8.4+UW96.12) with ESMTP id OAA16415 for ; Mon, 10 Feb 1997 14:52:13 -0800 Received: from localhost (localhost [127.0.0.1]) by skate.cs.washington.edu (8.8.3/7.2ws+) with SMTP id OAA12295 for ; Mon, 10 Feb 1997 14:52:12 -0800 Message-Id: <199702102252.OAA12295@skate.cs.washington.edu> To: uwracing@u.washington.edu Subject: An electronic license application... Date: Mon, 10 Feb 1997 14:52:11 PST From: Peter VanVleet Emerson was good enough to check with Gregg's and found out that their forms don't have a NCCA (collegiate) category. He also provided me with this electronic copy, taken from the USA Cycling website. You can just print it out and mail it in. I was even kind enough to fill in you school and USCF Club information. :) Thanks, Peter -------------------------------------------------------------------- Mail to: USA Cycling License Desk Questions? One Olympic Plaza Call 719-578-4949 Colorado Springs, CO 80909-5775 Email membership@usacycling.org NO FAX OR EMAIL APPLICATIONS WILL BE ACCEPTED. Please either: (1) edit this text file so as to provide the requested information, then print and sign it, or (2) print the form then fill it out by hand or typewriter and sign it. In order to be accepted the ACKNOWLEDGMENT OF RISK AND RELEASE FROM LIABILITY must be printed in at least 10 point type (about 1/8 inch high). In order to keep columns aligned, this form should be printed in a fixed-width font, such as 10 point Courier. 1997 USA CYCLING MEMBERSHIP APPLICATION MEMBER INFORMATION - PLEASE PRINT 1. Check one: ___ New member; applicants for USCF, NORBA or USA Cycling licenses see NOTES at the end. ___ Renewing; please give license number(s): USCF ___________ NORBA ___________ NCCA ___________ International ___________ 2. Name ________________________________________ 3. Mailing Address _____________________________ 4. City ___________________________ 5. State ______ 6. Zip ___________ 7. Date of Birth ______________________ 8. Male ___ Female ___ 9. Phone (_____) _______________ 10. USCF Club, if any _Husky Racing_______________________________________ 11. NCCA School (no abbreviations) _University of Washington______________ 12. USCF Categories: If you were upgraded in the last year, please attach a copy of your old license. Categories are assigned based on performance. All new competitors are assigned category 5 for men and category 4 for women for both road and track. 13. NORBA Rider Categories (see NOTES at end; put one check in each column) Cross Observed Country Downhill Trials New Competitor (Beginner) ____ ____ ____ Intermediate (Sport) ____ ____ ____ Advanced (Expert) ____ ____ ____ Semi-Pro (requires approval)____ ____ Pro (requires approval) ____ ____ ____ 14. NCCA Rider Category (your choice; put one check in each column) Road Track Mountain Bike Beginner (D)____ (D)____ (D)____ Intermediate (C)____ (C)____ (C)____ Experienced (B)____ (B)____ (B)____ Advanced (A)____ (A)____ (A)____ For information on how to obtain an official's, coach's or mechanic's license when you do not now hold one, see QUALIFYING FOR NON-RIDER LICENSES at the end. ANNUAL MEMBERSHIP FEES Note that a USA Cycling (i.e. International) license is required for racing outside the United States (also coaches and mechanics who serve in such capacity in International events outside the U.S.). Appropriate USCF or NORBA license fees for domestic events must be paid in order to obtain a USA Cycling International License. 15. Basic Membership (free to those who will be age 14 or under on 12/31/97, $20.00 for all others): $ ______ 16. Racing licenses for: USCF add $15.00 $ ______ 17. NORBA add $15.00 $ ______ 18. NCCA (Collegiate) add $15.00 $ ______ 19. USA Cycling International Racing License add $20.00 $ ______ 20. Officials license for: USCF (renewal only) add $15.00 $ ______ 21. NORBA (renewal only)add $15.00 $ ______ 22. Mechanics license for: USCF (renewal only) add $15.00 $ ______ 23. 24 hour processing service add $20.00 $ ______ (see NOTES at end) 24. Optional Donations for: US Cycling Team $ ______ 25. NCCA John Stenner Fund $ ______ 26. NORBA Worlds Team $ ______ 27. Land Access $ ______ 28. TOTAL AMOUNT DUE - enclose check or money order payable to USA Cycling; or provide credit card information below. $ ______ Visa or Mastercard Card Number ________________________________ Expiration Date _________ Signature of Card Holder __________________________ The following must be signed. ACKNOWLEDGMENT OF RISK, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT (With Consent of Parent or Guardian of Minor) This agreement is given by the undersigned Applicant for the benefit of USA Cycling, Inc. ("USAC") and its respective divisions and associations including USCF, NORBA, USPRO and NCCA, employees, agents, members, sponsors, promoters and affiliates (collectively "Releasees"). I acknowledge that cycling is an inherently dangerous sport in which I participate at my own risk and that USAC and its associations are non-profit corporations formed to advance the sport of cycling, the efforts of which directly benefit me. In consideration and as a condition of my membership in and the issuance of a license to me by USAC, USCF, NORBA, USPRO or NCCA, 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 and 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 of Releasees in connection with the sponsorship, organization or execution of any bicycle racing or sporting event, including travel to and from such event, in which I may participate as a rider, team member, spectator or in any other manner. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as a consent to any other provision herein or as a consent to any subsequent waiver or modification. I currently have no known physical or mental condition that would impair my capability and am fit to fully participate in bicycle racing (except for __________________________________________________________). X _________________________________________ Date ____________________ 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 "Releasees" that the facts herein concerning my child or ward are true. I give my permission for my child or ward to enter any bicycle race or event permitted by USAC 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. X___________________________________________ Date ____________________ Signature of Parent or Guardian (in ink) NOTES The following instructions apply to certain information requested above. Item 1: NEW MEMBERS (USCF, NORBA or USA Cycling licensees). Proof of nationality is required for applicants who wish to have a USA Cycling license and proof of U.S. citizenship is required for those who wish to enter USCF Senior National Championships. Permanent Residents may enter certain other USCF championships provided that they provide proof. Proof of age is required for all USCF riders. Submit a copy of your birth certificate, passport, resident card, or naturalization papers. Other forms of documentation may be accepted. Item 13. NORBA CATEGORIES. Upgrades through Expert may be done at the time of renewal or by an official at an event. Upgrades to Semi-Pro or Pro level must be reviewed and approved by the NORBA Competition Director -- submit racing resume with request. Downgrades from any level require approval. Submit your written downgrade request with the renewal. Item 19. USA CYCLING LICENSES are required to compete outside the U.S. and for international races within the U.S. They expire on December 31 of the year for which they are issued. Applicants must also complete the USA CYCLING LICENSE SUPPLEMENT, below. Item 23. If you need 24-hour turn-around on processing your 1997 License you must do the following: 1. Enclose the additional $20 processing fee shown in Item 23; 2. Mark the outside of envelope "Express"; 3. To receive your license back via Express Mail, enclose a pre-addressed and pre-paid express or overnight return envelope (otherwise, your license will be returned via regular first-class mail). QUALIFYING FOR NON-RIDER LICENSES To obtain a NORBA OFFICIAL'S LICENSE when you have not held one before, contact NORBA at 719-578-4717 for details on officials licensing clinics. To obtain a USCF OFFICIAL'S LICENSE when you have not held one before, contact your District Representative or the USCF to enroll in a Category 4 official's licensing seminar. To obtain a USCF COACH'S LICENSE you must participate in the Coaching Education Program. For information contact the Manager of Coaching Programs at 719-578-4845, extension 9, or at email address mwrcmgn@aol.com. To obtain a USCF MECHANIC'S LICENSE you must participate in a mechanic's clinic. For information contact the USAC Head Mechanic at 719-578-4581. All listed fees are for the current membership year only and are subject to change without prior notice. .