TOUR ENTRY FORM (photocopies accepted
Name_____________________________________Address_________________________________
City_________________________________________________State________Zip______________
Phone ( )____________________________Male____Female______Age______(as
of Aug.21st,2010)
____12 mile______22 mile T-shirt
size
__________
____38 mile______62 mile Registration
Fee $20.00 for early-birds,$25.00 after 1st Aug.2010
___________
Please select one
of the above
Mighty
Kids ride- Kids 8 & under. ___Free_____
.Note: This
event will be held regardless of Kids
14 & under receive a $5.00 discount: ___________
weather.
Registration fee is non-refundable
Extra T-shirts: $10.00 ea. (?
Size_______):_____________
Total
Amount Enclosed :___________
Waiver: In
consideration of the acceptance of this entry. I the undersigned assume all
risks and full and complete responsibility for any injury or accident which may
occur during my participation in any of the Vernon Burnin Bike Ride events., or while I am on
the premises of the event, and I hereby release and hold harmless the sponsors,
Promoters, and all other persons and entities associated with the event from
any and all injury or damage and liability. I acknowledge that I am familiar
with the dangers involved in participating in such an event and that there may
be defects in the riding surface or other permanent or temporary obstacles
which I must be careful to avoid. I also recognize there may be vehicular
traffic along the course. I understand that a bicycle is a legal vehicle in the
State of