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BBC CENTURY & DOUBLE CENTURY
OFFICIAL ENTRY FORM (On-line registration
available at bhambikeclub.org) NAME:___________________________________________________ADDRESS:________________________________________________ CITY/STATE/ZIP__________________________________________ PHONE _____ ________________E-MAIL ________________________________________________EMERGENCY CONTACT NAME __________________________ EMERGENCY PHONE ________ ________________________ AGE:________ MALE FEMALE BBC MEMBER? Y / N HAVE YOU RIDDEN THIS EVENT BEFORE? Y / N INTENDED ROUTE: (CIRCLE ONE) 31, 50, 64, 103, 200T-SHIRT SIZE (OPTIONAL) S M L XL XXL ***PRE-REGISTER TO GUARANTEE SIZE*** RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK,
AND INDEMNITY AGREEMENT IN
CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN ANY WAY IN THE 1) Acknowledge that I understand that
bicycling is a strenuous and potentially hazardous activity and that I am
qualified, in good health, and proper physical condition to participate in
the BBC Century. I further acknowledge
that the BBC Century will be conducted on public roads and facilities open to
the public where the hazards of traveling are to be expected and that risks
may arise from my own actions or inactions, the actions or inactions of
others or the conditions in which the BBC Century takes place, and I fully
accept and assume such risks and all responsibility for losses, costs and
damages I incur as a result of my participation in the BBC Century. 2)
Hereby release, discharge and covenant not to sue the BBC, LAB, their
respective administrators, directors, agents, officers, members, volunteers
and employees, other participants, sponsors, advertisers, and owners and
lessors of premises on which the BBC Century takes place, from all liability,
claims, demands, losses, or damage on my account. ________________________________________________________________ signature
of participant
date ________________________________________________________________ signature
of parent or guardian if participant is under age 18 (under 16 must ride with
an adult) EVERY RIDER MUST WEAR A HELMET!!! |
Complete and sign this form (one per rider) and mail
with check or money order to: REGISTRATION OPTIONS: PRE-REGISTER THROUGH 8/24/07……$25 T-SHIRT (size
guaranteed)..$ 8 AFTER 8/24 (and DAY OF
EVENT)…..… $30 T-SHIRT (if
available)……$10 ***Under Age 18 can ride for just $5!*** |