Registration Form
Print this
page, fill out, sign, and send with your payment to address at bottom
(submit one form per rider)
Name:
__________________________________________ Phone: ______________________
Address:_____________________________________________________________________
City:_______________________________________________ State: ______Zip: __________
e-mail address________________________________________________________________
(you will receive an e-mail confirmation of receipt)
Emergency Contact:
(name & phone
number)________________________________________________________
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Entry fees: |
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3-Mile Kiddie Ice Cream Cruise |
$6.00 |
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15-Mile Rogue River Route |
$20.00 |
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25-Mile Riverside Ramble |
$35.00 |
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60-Mile South Coast Tour |
$40.00 |
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100-Mile Coastal Challenge (includes lunch) |
$50.00 |
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Entry fee discounts: (Not applicable toward the 3-mile nor 15-mile entry fees) |
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| Really-early entry (postmarked before June 15,2007) |
- $10.00 |
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Kinda-early entry (postmarked before August 15, 2007) |
- $5.00 |
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Members of a group of four or more (all entries must be submitted together) |
- $5.00 |
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Extras: |
quantity |
total |
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2007 Oregon Coast Cycling Festival Long-sleeve T-shirt (Specify size: ( ) M ( ) L ( ) XL ) |
$19.00/ea |
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2006 Oregon Coast Cycling Festival Long-sleeve T-shirt (Specify size: ( ) L ( ) XL ) |
$15.00/ea |
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2005 Oregon Coast Cycling Festival Long-sleeve T-shirt (Specify size: ( ) L ( ) XL ) |
$10.50/ea |
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2004 Oregon Coast Cycling Festival Long-sleeve T-shirt (Specify size: ( ) L ( ) XL ) |
$10.50/ea |
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Souvenir Canvas Tote Bag |
$7.50/ea |
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| Lunch Ticket |
$6.50/ea |
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Total: |
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In consideration of the acceptance for entry into the 2007 Oregon Coast Cycling Festival, I hereby waive, release, and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which hereafter may accrue to me, as a result of my participation in said event. This release is intended to discharge in advance the promoters, sponsors, Oregon Coast Cycling Festival, its officers and members, and personnel associated with the 2007 Oregon Coast Cycling Festival of any and all liability arising out of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that said event will require me to engage in strenuous physical activity at high altitude, and in possible adverse weather conditions. I further understand that serious accidents occasionally occur during bicycle riding, and that participants in bicycle riding occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof. Knowing the risks of bicycle riding, nevertheless, I hereby assume those risks and do hold harmless all the person or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or my heirs or assigns) for damages. It is further understood and agreed that this waiver, release and assumption of risk, is to be binding on my heirs and assigns. I acknowledge that an ANSI certified helmet is required to be worn by me at all times while riding a bike in this event. All riders must check in at starting area no later than 15 minutes before their rides begin and as soon as possible upon finishing. Riders cannot leave earlier than posted start times.
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Signature of
Rider__________________________________________________________________________Date __________ Signature of Parent or Guardian ______________________________________________________________ Date __________ (required if rider is under 18 years of age) Send form(s) with check payable to; |
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