[ Home ] [ Up ]

Up

A check or money order must accompany each registration, in the amount of $15.00 if post marked on or before Sept.1, 2008 and $20.00 thereafter.  Less than 10 years old free with registered adult.  Make payable to Berks Co. Bicycle Club.              

Detach and Mail to: BCBC c/o Tom Donkin, 103 Mediterranean Ave., Sinking Spring PA 19608.  610-670-4875   E-Mail  donkint@msn.com

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 

2008 SHOO-FLY CLASSIC REGISTRATION FORM

NAME___________________________________­­­_____    ADDRESS ____________________________________________________

CITY______________________________________   STATE_________ ZIP_________      TELEPHONE # ______________________

EMERGENCY CONTACT_______________________________________       TELEPHONE # _________________________________

E-MAIL ______________________________   TOTAL RIDER(s) SAME ADDRESS ______ X $ ______ = Amount enclosed $_________

WAIVER

HELMETS ARE REQUIRED. I understand that the League of American Bicyclists requires bicycle helmets to be worn by all participants in all League sponsored rides while operating bicycles and that there is no exception to this requirement. I agree to wear a bicycle helmet at all times during this event when I am operating a bicycle. I am aware of the risks of bicycling and otherwise participating in this event and voluntarily assume all such risks. I acknowledge, agree and represent that I understand the nature of bicycling activities and that I am qualified, in good health, and proper physical condition to participate in such activity. I further acknowledge that the activity will be conducted over public roads and facilities open to the public during the event and upon which the hazards of bicycling are to be expected. In consideration of being permitted to participate in this event: (1)I release for myself, my heirs and personal representatives and the undersigned registrant under age 18 (minor), the League of American Bicyclists, Inc., the Berks County Bicycle Club Inc. and their respective directors, officers, volunteers, and staff (indemnities) from any claim, liability, demand, action and cause of action whatsoever (collectively, ”Claim”) arising out of or related to any loss, damage, or injury (collectively, “Loss”), to myself or my property, that I may sustain in connection with or arising out of this event;(2)If registered as a minor, I (as a parent or guardian) agree to indemnify and hold harmless each indemnitee against any claim for any loss said minor may sustain in connection with defending any claim by on behalf of said minor for any such Loss;(3)consent to emergency medical treatment if I am injured(4)shall obey traffic laws and practice safety in bicycling and(5)agree to wear an ANSI or SNELL approved helmet on all bicycle riding activities at this event;(6)minor must be accompanied by an adult. If no signature of guardian appears below, registrant is deemed to confirm being at least age 18.