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A.J.S. Motorcycle Club of WA Inc.
Postal Address: PO Box 2678
Ellenbrook 6069
Telephone: Ken 0412 851 378
2015 Associate Membership Form
Price: $120.00
WARNING! THIS MEMBERSHIP FORM AND ATTACHED RULES AND REGULATIONS, ARE
IMPORTANT DOCUMENTS THAT AFFECT YOUR LEGAL RIGHTS AND OBLIGATIONS. READ ALL
THE DOCUMENTS CAREFULLY AND DO NOT SIGN THIS MEMBERSHIP FORM UNLESS YOU
ARE COMPLETELY SATISFIED THAT YOU UNDERSTAND THE CONTENTS AND AGREE
TO BE BOUND BY THEM.
Surname: ______________________________ Given Name/s: ________________________________
Street Address: ______________________________________________________________________
Suburb: __________________________ Postcode: ___________ Phone No: _____________________
Occupation: _____________________________________ Birth Date: ___________________________
You Must Have a Current MWA Competition Licence before Riding with A.J.S.M.C.C Inc
Licence No.___________________ Expiry Date___________ Race No__________ MWA Grade______
Please Note:
Associate members are not entitled to any of the privileges associated with being a full member of
the A.J.S. Motorcycle Club of W.A. Inc.
No points will be awarded to Associate members.
No trophy will be awarded to any Associate member.
No key will be given to any Associate member.
No newsletter will be received by any Associate member.
You will only be eligible to ride Four (4) only club events, after this time you may join as a full member and
your $120.00 will be deducted from the cost.
Cost per Race Day for Associate Members:
Cost per Race Day 2nd Class for Associate:
Office Use Only:
Amount Paid
Cash

Receipt #: __________________________
$50.00
$25.00
Cheque

Direct Debit

A.J.S. Motorcycle Club of WA Inc.
Postal Address: PO Box 2678
Ellenbrook 6069
Telephone: Ken 0412 851 378
Acknowledgement and Assumption of Risks, Dangers and Obligations
I acknowledge that Motorcycle Racing is dangerous and that by engaging in the riding of motorcycles as part of
the A.J.S. Motorcycle Club of WA Inc or by attending at the premises of the A.J.S Motorcycle Club of WA Inc I
am exposed to certain risks and dangers and under certain obligations, which risks and dangers and obligations
I accept and participate in at my own risk. The risks, dangers and obligations include but are not limited to:
a) I may be injured, physically or mentally and may be killed;
b) That my property including machinery or equipment may be damaged lost or destroyed;
c) That other riders may ride dangerously or with lack of skill;
d) That the conditions of the track may be hazardous and may vary without warning or predictability;
e) That any policy of insurance or in respect of my life or physical or mental health may be void;
f) That there may be no or inadequate facilities for treatment and transport of me if I am injured;
Right to use Image
I acknowledge and consent to photographs and electronic images (including, but not limited to , moving images)
being taken of me during my participation in any event. I acknowledge and agree that such photographs and
electronic images are owned by the A.J.S Motorcycle Club of WA Inc and it may use the photographs and
electronic images for promotional or other purposes without my further consent being necessary. Further, I consent
to the A.J.S Motorcycle Club of WA Inc using my name, image, likeness and also my performance in the events, at
any time, by any form of media, to promote the A.J.S Motorcycle Club of WA Inc or the event.
Contract Excluding Liability
In consideration of the acceptance of my membership of the A.J.S Motorcycle Club of WA Inc I agree to absolute
and release from all liability the A.J.S Motorcycle Club of WA Inc, it’s members, servants or agents and the
authorities which own, occupy or manage the land on which motorcycle racing is to take place. For any injury or
damage to myself or my property arising out of participation in or as an observer to motorcycle riding, due to any
negligent act, breach of duty, default and /or omission on behalf of the A.J.S Motorcycle Club of WA Inc, their
members, servants or agents and the authorities which own, occupy or manage the land on which motorcycle
racing is to take place. I further acknowledge:
a) That I am a member and attend at the A.J.S Motorcycle Club of WA Inc at my sole risk and responsibility;
b) That I accept the property as it stands with all or any defects hidden or exposed;
c) That I will ride in a manner, which is safe, and with all due care and attention.
Members Name: ____________________Signature: ____________________ Date: ______________
I/We the Parents/Guardian/s of the member hereby acknowledge that I/We have read the whole of the documents
and understand it. I/We consent to the member being a member of the A.J.S Motorcycle Club of WA Inc and that
I/We are aware of the risks, dangers and obligations set out above and I/We agree to indemnify the A.J.S
Motorcycle Club of WA Inc in respect of any claim arising out of any physical or mental injury or damage to
property. I/We being the Parent/Guardian of the applicant named above, agree to this application being
submitted under the terms described above.
Parents/Guardian/s Name: __________________ Signature: __________________ Date: ___________