(Please read carefully before signing and then printout out and send with enclosed membership fee)
I
 Individual ($20.00)
F
Family ($30.00)  USAT Tri  #:
USTA

The Las Vegas Triathlon Club annual individual membership is $20.00 for new members and $30.00 for families. To receive the family discount, each member must fill out their own membership (signed & dated) and mail them in together with the membership fee. Members will receive products and discounts from sponsors as available.  Please make your check payable to: Teresa Terlizzi, 2831 Via Florentine St. Henderson, NV. 89014 

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Legal Stuff:                                                 Club Waiver (must be signed and dated)

Please read carefully before signing  and dating acknowledgement, waiver, and release form liability(AWRL)

I acknowledge that the triathlon or multi-sport is an extreme test of a persons physical and mental limits and carries with it the potential for death, serious injury, and property loss.  I hereby assume the risks of participating in all triathlon club functions.  I certify that I am physically fit, have sufficiently trained for participation in this event(s), and have not been advised otherwise by a qualified medical person.  I acknowledge that my statements on this AWRL are being accepted by the USA Triathlon (USAT) in consideration for allowing me to become a club member in a USAT Chartered Club and are being relied upon by USAT and the club organizers and administrators in permitting me to participate in any organized club function.

In consideration of for allowing me to become a Las Vegas Triathlon Club member, a USAT Chartered Club and allowing me to participate in organized club functions, I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors, and assigns: a) I AGREE to abide by the competitive rules; b) I waive, release, and discharge from any and all claims or liabilities for death, personal injury, property damage, theft, or damages of any kind, which arise out of or relate to my participation in, or my traveling to and from an organized club function, the following persons or entities;Las Vegas Triathlon Club, USAT, USAT Chartered Clubs, club sponsors, volunteers, all states, cities, countries, or localities in which club functions or segments of club functions are held, and the officers, directors, employees, representatives, and agents of any of the above; c) I agree not to sue any of the persons or entities mentioned above for the any of the claims or liabilities that I have waived, released, or discharged herein; and d) I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions during an organized club function. By signing below, I also hereby authorize the Club to include my name in newsletter or newspaper stories including articles posted on the web. I also grant the Club express permission to use photographs of myself in Club newsletter, website, or newspaper articles and for submissions to Club sponsors.

I hereby affirm that I am eighteen (18) years of age or older, I have ready this document and I understand its' contents.

By signing below, I also hereby authorize the Club to include my name in newsletter or newspaper stories including articles posted on the web. I also grant the Club express permission to use photographs of myself in Club newsletter or newspaper articles and for submissions to Club sponsors.

Signature (required):____________________________ Date: ______________

Your canceled check serves as your receipt. Memberships are annual from the date we receive fees.

Official Use only:  Cash: ____ Check Number: ________Start Date: _____Renewal Date:_____