| Pre-Registration Deadline |
April 15 , 2011 |
$20.00 |
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| Registration Deadline |
Day of event - May 15, 2011 |
$25.00 |
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Children under 18 - FREE with Adult |
$0.00 |
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| Name |
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| Address |
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| Phone |
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| Email |
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| Are you over 18? |
YES NO - an Adult must sign for anyone under 18 |
| T-Shirts |
Indicate Size and Qty - Adult
__S __M __L __XL
|
$13.00 each |
| RELEASE OF ORGANIZERS OR SPONSORS: All applicants must
sign this release. In signing this release for myself or the name registrant
(if under age 18), I acknowledge that I understand the sponsors and
their officers, members, employess, and ride organizers are not insurers
of my safety during the Bike Branch County Ride, or any activities
associated therewith. I thus release them and agree to hold them harmless
from any and all liability arising from my having sustained any property
damage or personal injury by reason of participating in or sponsoring
or planning, or arranging the event. I also hereby consent to permit
emergency medical treatment in the event of injury or illness. I shall
abide by all traffic laws and regulations and practice courtesy and
safety in cycling. Helmets are required while riding in the Bike Branch
County Ride. NO EXCEPTIONS. |
SIGNATURE:
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Make checks/money orders payable to: The Community Foundation,
with "The Bike Branch County Fund" in the memo line. A $25.00 returned check
fee will be applied to N.S.F. checks. No refunds will be granted for a cancellation
request due to the nature of charity.
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