*By providing your email address, you consent to TCWA to contact you via email with newsletters and promotional offers. Should you wish to opt out please email:treasurer@trackcyclingwa,com.au PO Box 3021, MIDLAND WA 6056 ABN: 25 458 078 956 firstname.lastname@example.org Club Membership Form Application Fee = $30.00 TCWA Membership FormGiven Name*Surname*Gender*FemaleMaleDOB*Click in field to choose date Email Address*MobileAddress*Suburb*Postcode*• In consideration of Track Cycling WA inc. accepting my application for membership, I agree that the association, its members and officials will not be held responsible for any personal injury or property damage or loss suffered by me. I also release the association from any liability for negligence.• I acknowledge that I will be riding at my own risk. I further understand that track cycling is an endurance sport that requires a high degree of fitness and accept the risk that I may suffer illness or injury if I take part in such a sport while insufficiently fit or healthy.• I further agree I accept the clubs rules, constitution and rules for race conduct if I choose to race in scheduled race events.• This membership is solely a membership to Track Cycling WA, and I understand that this membership allows me to train and ride on scheduled training nights at membership rates. It does not allow me to race without a racing licence. I further understand that if I wish to race in scheduled events that I need to seek a racing licence with Cycling Australia.Emergency Contact DetailsMobileParent / GuardianMobileFull Name of person submitting Form*Date*Membership Fee*Single - $30.00TCWA ExecutiveDateSubmitIf you are human, leave this field blank.