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2010 PACIFIC POPULAIRE - April 4 PRE-REGISTRATION FORM (due Tuesday, March 30) |
print entry and mail to: BC Randonneurs
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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