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Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Personal Information

Date of Birth *

Year *

Month *

Day *

Your Date of Birth will be used for the Leaderboard filtering. Your age will never directly be displayed.

Parent or Guardian

Parent or Guardian's Date of Birth

Month

Day

Year

If you are under 18 years of age, please add the date of birth of your parent or legal guardian.

Contact Information

Address

Country *

Address 1 *

Address 2

City *

Province *

Postal code *

Privacy Settings

Membership

Payment Method *

Cash - not available for 2021

Cheque - by mail or in-person during our Walk-in Registration Dates

Interac E-transfer - send it to aplvncccorp@gmail.com. No need for a secret password. We autodeposit.

Paypal - online only. Click here to open the Paypal Payment page in a new window, so that you can make the payment when you finish submitting this form.

Credit Card (Visa, MasterCard, American Express), Apple Pay or Debit Tap - not available for 2021

To pay by mail, send a Cheque or Cash, to the following Mailing Address:

Amici per la Vita Niagara Cycling Club
c/o Klein Development Ltd.
6279 Huggins Street
Niagara Falls, Ontario
L2J 1H2

**Make the cheque out to APLV Niagara.

Legal

I have read and agree to the Membership Agreement *

BY CHECKING THE BOX ABOVE ("I AGREE TO THE MEMBERSHIP AGREEMENT") WHEN SIGNING UP TO BE A MEMBER OR RENEWING MY MEMBERSHIP I ACKNOWLEDGE THAT I HAVE READ THE MEMBERSHIP AGREEMENT, FULLY UNDERSTAND IT’S TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

Parent or Guardian Signature

If you are under 18 years of age, please ask your parent or legal guardian to enter their e-signature here.
In the Signer Title please have them enter either Parent or Guardian or whatever their legal relationship is with you.

Parent or Guardian Signature

If you are under 18 years of age, please ask your parent or legal guardian to enter their e-signature here.

In the Signer Title please have them enter either Parent or Guardian or whatever their legal relationship is with you.

Signer Name

Signer Title

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