(Please Print clearly)                                                  Registration Form  
         
Name:_________________________                                    Read Carefully:                                  
                                                                                  I am aware that during the bike ride      
Address:_______________________         under the sponsorship in which I am participating  
                                                                                 of the Celo Inn, the Bicycle Inn,

City:____________________                       their sponsors, and agents, employees, and associates,   
                                                                    certain substantial risks and dangers exist in cycling    
St./Prov.___________________                                   including but not limited to:                 
                                                                              wet, slippery, and rough road surfaces,           
Zip code__________________                           traffic hazards, and the forces of nature.
                                                                             I do hereby assume all of the above risks.
Telephone_____/_____/_____                            and release the above mentioned sponsors,  
                                                                               their agents, employees, and associates                      
E-mail _______________________             from any and all liability, actions, debts, claims,
                                                                     and demands of every kind and nature whatsoever 
Emergency Contact: ___________________         which I now have or which may arise
                                                                                     out of or in connection with my
and phone number: ______/______/______                      or participation in it.
                                                                             The terms hereof shall serve as a release,          

T-shirt size:                                               indemnification, and assumption of risk for my heirs,
 S___M___L___XL___XXL___            executer, and administrators for all members of my family,
Fee $25 (before April 1- $35 after)                         including any minors accompanying me.    

Make checks payable to                                                                                  
           Energy Xchange                                     Signature______________________
Enclosed: check #______                             Parent or legal guardian must sign for riders under 18.
    

Credit card - __________________                                           
Expiration date: ___/___/___