RRRC
PBMC Registration
Form
Name _______________________ Address _______________________
City_______________________________ State _____ Zip ___________
E-Mail _________________________________
Emergency Contact: _____________________ Telephone # ________________________
Please
circle the distance you intend to ride:
100K 50K
|
Waiver Each
participant must read and sign! If
you are under 18 years of age, you must have a parent’s or guardian
signature on this waiver. If you
are under 12 years of age, you must be accompanied on the ride by a parent or
guardian. I, the undersigned
agree to indemnify and hold harmless the Rocky River Road Club and their
sponsors from all cost, expense and liability arising out of my or my
child’s participation in this event. I
acknowledge that bicycling may be dangerous and involves the risk of serious
injury and or property damage. I
do hereby waive all claims for damage or loss to me or my child’s person or
property which may be caused by any act or failure to act by the Rocky River
Road Club and all other persons involved and or associated with this event
that may arise directly or indirectly from my or my child’s participation
and I hereby assume liability for any loss, damage or other liability for any
loss, damage or other liability for such event. ________________________________________
__________________________________________ Participant’s
Signature
Date
Guardian’s Signature
Date
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For
Advance Registration: Mail with
Check or Money Order to:
Rocky
River Road Club
PO Box 1435
Davidson,
NC 28036
Must
be post marked by Wed. Jan. 9th
Ride Day Registration $20