NAME (last name first)_________________________ AGE _____ SEX F M

ADDRESS_________________________________ PHONE (___)__________

CITY________________________ STATE________ ZIP_______________

EMAIL ADDRESS________________________________________________

BIRTHDATE ___/___/___  I have participated _____ times. Classic Participant

WAIVER/RELEASE FORM
Waiver - I know that bicycle riding is a potentially hazardous activity. I should not enter and ride unless I am medically able and properly trained. I also assume any and all other risks associated with riding this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and the conditions of the roads, all such risks being known and appreciated by me. Knowing these facts, I hereby, at my own risk enter this event. I, my estate, and my heirs waive any claims for damages or injuries that I may incur as a result of my participation in this event, against any sponsor, volunteers, employees or officials. I understand that helmets are required for all riders. I am well aware that I'm expected to ride with courtesy, caution and common sense. I know this ride is held rain or shine and the registration refunds will not be made.