Make Check Payable to:
River Valley Bicycle Club

 

ENTRY FORM

Send to: River Valley Bicycle Club
P.C. Parks & Recreation
Courthouse Annex
Cannelton, IN 47520

Please indicate shirt size: S, M, L, XL
(T-shirt orders must be received by 9-26-03)

Name (Please Print) Age Address Signature (Each rider must sign) T-shirt size
$10.00
Entry Fee
$10.00/$16.00
Total Cost
             
             
             
             

RELEASE OF ORGANIZERS AND SPONSORS:

In consideration of the acceptance of this application and participation in the Falling Leaves Bicycle Tour, I hearby waive, release and discharge any and all claims for damages for death, personal damage which may happen during the event. I hearby release and hold harmless River Valley Bicycle Club and any contributors to this event from and against any and all liabilities arising from or connected with my participation in this event. I further understand that a bicycle is a legal vehicle of the road in the state of Indiana, and I will ride in accordance with the Indiana Vehicle Code. I also agree to be a safe and courteous rider and I agree to wear a helmet at all times while riding my bicycle. Entry not valid without a signature.

*** ALL RIDERS UNDER 16 YEARS MUST BE ACCOMPANIED BY AN ADULT AND THIS FORM SIGNED BY PARENT/GUARDIAN FOR ALL REGISTRANTS UNDER 18 YEARS OF AGE.

 

(Date)__________________

Rider (Signature) ______________________________________
 

Adult (Signature) ______________________________________
(If rider is under age 18)