PBMC Home

 

Registration Form

 

Metric Route Sheet

 

Half Metric Route Sheet

 

 

 

 

 

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

 

                 

 

 

For Advance Registration:  Mail with Check or Money Order to:

Rocky River Road Club

PO Box 1435

Davidson, NC 28036

www.RockyRiverRoadClub.com

 

Must be post marked by Wed. Jan. 9th.  Pre-registration fee $15.

 

Ride Day Registration  $20