| Primary Riders Printed Name: |
| Address |
Phone |
| City |
State |
Zip |
| Registration Fees- the earlier you sign up the more you can save |
Price |
Qty |
TOTAL |
Regular Entry:
mailed by August 25, 2007 |
$8.00 |
x |
$ |
| Day of Ride Entry: |
$10.00 |
x |
$ |
| Children under 16 |
Free |
x |
|
| Make checks payable to the "BCBCBCBC" TOTAL |
$ |
|
ALL RIDERS MUST READ AND SIGN THIS RELEASE FORM!
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In signing this release for myself, I acknowledge that I have read and understand it’s intent. I understand that the Cincinnati Cycle Club Inc., North Adams High School, the city of Seaman, Ohio, its officers, board members, and/or contractors are not insurers of my personal safety during the BCBCBCBC Bicycle Tour and other related activities. I thus release them and agree to hold them harmless from any liability arising from my having sustained any property loss, damage, or personal injury by reason of their negligence in participating in, sponsoring, or arranging this event. I also hereby consent to and permit emergency medical treatment in the event of any injury or illness. I AGREE TO WEAR
CERTIFIED BICYCLE HELMET WHILE RIDING MY BICYCLE. I shall abide by all the traffic laws and regulations of the States of Ohio. I will practice courtesy and safety in cycling at all times. I understand that no refunds will be issued for any reason, including non-attendance, after August 25th, 2007. This event is rain or shine. No alternate rain date. |
| Rider's PRINTED Name: |
Rider's/Guardian's(if under 16) SIGNATURE |
Date |
Age |
| 1 |
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| 2 |
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| 3 |
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| 4 |
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