COGGS INCORPORATED MEMBERSHIP APPLICATION

&

HOLD HARMLESS AGREEMENT

www.coggs.com

I acknowledge that bicycling and related activities are potentially HAZARDOUS and I have made a voluntary choice to participate in those activities despite the risks that they present. In consideration of being permitted to participate in the activities coordinated Cyclist Of Gitchee Gumee Shores Incorporated D/B/A COGGS, I agree to ASSUME ANY AND ALL RISKS OF INJURY, DEATH, OR DAMAGE TO PROPERTY which may be associated with or a result of my participation in COGGS activities. (Please check the box after reading and understanding the above paragraph.)

I understand that conditions can and do vary constantly. Obstacles exist, both natural and man-made. I understand it is my responsibility to be aware of the varying conditions and avoid all obstacles, both natural and man-made. (Please check the box after reading and understanding the above paragraph.)

I further agree to RELEASE FROM LIABILITY AND TO INDEMNIFY AND HOLD HARMLESS COGGS, it's officers, members, sponsors, agents, landowners, affiliated companies, or anyone or anything else possibly connected with COGGS activities for any damage, injury or death to myself or to any person or property, weather caused by their NEGLIGENCE or for any other reason. (Please check the box after reading and understanding the above paragraph.)

I, the undersigned, have carefully read and understood this agreement and all it's terms. I understand that this is a RELEASE OF LIABILITY which will legally PREVENT me or any other person from filing suit or making any other legal claim for damages in the event of my death or any injury to me. I nevertheless enter into this agreement freely and voluntarily and agree that it is binding upon me, my heirs, assigns and legal representatives. (Please check the box after reading and understanding the above paragraph.)

Information:

Last Name:		First Name:		Birth Date:	//
Address:
City:		State:		Zip Code:
Phone:		Email:

Type of Membership

	$100 Sponsor/Corporate		$20 Regular Membership
	$15 Student Membership		$30 Family Membership

Additional Contribution: $

Our Corporate Sponsors

		Haag Built LLC FINE CARPENTRY 1821 Wallace Ave // Duluth, MN

Trail Building Supplies Generously Donated By