Membership Registration Form

Full Name

Email Address *

Mobile / WhatsApp Number

Date of Birth

Gender

Rider Experience

Primary Bike Type

Average Weekly Riding Distance

Emergency Contact Name

Emergency Contact Number

Code of Conduct Agreement

Communication Consent

Anything We Should Know?

(Injuries, goals, experience, or expectations)

Medical Aid

of If Experience

Medical Aid Provider

Medical Number

Do you have any medical conditions we should be aware of?

If yes, please provide details

eg Asthma Diabetes Heart condition Allergies Previous injuries

Emergency Consent Agreement

I confirm that the above medical information is accurate and I understand that I participate in club activities at my own risk. In case of emergency, I authorize Nexus Cycling Club to seek medical assistance on my behalf.

Indemnity / Liability Waiver

I understand that cycling is a physical activity with inherent risks and I release Nexus Cycling Club, its members, and organizers from liability for injuries sustained during participation.

Club Policies & Compliance

Cell: +27 83 250 6473 | Email: info@nexuscycling.co.za