2008 Roan Moan
Registration Form
Copy the form below and paste
in your "writing program" and please print clearly.
Name:________________________
Read Carefully:
I am aware that during the bike ride
Address:______________________
under the sponsorship in which I am participating
of the
Bakersville Volunteer Fire Dept,
City:____________________
and their their agents, employees, and associates,
certain substantial risks and dangers exist in cycling
St./Prov._________________
including but not limited to:
fatigue,
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,
including any minors accompanying me.
Fee
$30 (before July 1- $40 after)
If at any time during the event circumstances
Make checks
payable to:
become too dangerous, I will cease and withdraw.
Bakersville BVF&R
Signature___________________________
Enclosed: check #______
Parent or legal guardian must sign
for riders under 18.
I plan to ride the century (100miles)________
metric (63 miles)_________
Signature_______________________________
quarter
(32 miles)_________
Highlight just the form, copy, and print.
Or: highlight, copy, and
paste in your "writing program" and print.
This is not an
electronic form. Please print and mail in.
PO Box 351
Bakersville, NC 28705
E-mail Michael