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Pacific Populaire
 

2010 PACIFIC POPULAIRE - April 4
PRE-REGISTRATION FORM
(due Tuesday, March 30)

print entry and mail to:

BC Randonneurs
7068 Mawhinney Close
Burnaby, BC  V5B 4W2

Name_______________________________________________________________

Address_____________________________________________________________

____________________________Postal Code____________________

Phone_______________ e mail________________________________

19 years old and over: members $15, non-members: $18 (Note: It's members $20, non-members $25 on ride day)
Under 19 years old: $10 ---> (You will need to have the waiver [below] signed by your parent or guardian)

Amount enclosed: $_____
(Please do not mail cash)  Distance: 25 km ___, 50 km ___ , 100 km ___
Make
cheques payable to: BC Randonneurs or pay by VISA:

VISA #: _____________________ Expiry Date:______ Name on Card: ______________________

~~~~~~~~~~All participants must complete this waiver~~~~~~~~~~~~

Waiver

I _________________________________understand that participation in a Randonneur event involves risk of injury to the rider's person and health and damage to their property. These risks are inherent in cycling a designated route in traffic for long distances. I accept that risk to the rider and agree not to hold responsible or sue the organizers and volunteers and their agents, designates or employees for liability for any death, loss, or injury to the person, health, or property of the rider however caused including by negligence.

I have had the opportunity to carefully read this waiver, and understand that by signing it I forfeit my right to sue.

 

____________________________________________
Participant's signature

____________________________________________
Parent or guardian's signature (if participant is under 19)

_________________________________, 2010
Date