LIABILITY WAIVER

In consideration of the BBC providing bicycling opportunities and allowing me/us to participate in its events, I/we  agree to assume the risks thereof.  Further, I/we release the BBC and its officers, directors, members and agents from any and all claims for death personal injury, or property damage which may accrue to me/us (or a minor in my care) as a result of participation in any BBC activity or event, even though the claim may arise out of negligence or carelessness on the part of the person or entities released.

Signed________________________________________________

____________________________  Parent/Guardian (for minor)

The liability waiver must be signed by each participant before participation.

Proceeds to be donated.

www.blairbikeclub.com

Consider joining the BBC!

We offer:   Club Rides... Summer Time Trials... Annual Bowling Day!, etc, etc!!!

Registrations welcome day of ride.  Please send your completed registration form and liability waiver to:

   BBC
         c/o Nannen PT
          636 N 20th Ave
            Blair, NE 68008

Questions?

email: blairbikeclub@yahoo.com

***LUNCH PROVIDED!

 

3 Ring Circuit Century Ride! 

  NEW DATE!!!

Sept 8, 2012, 7:30 a.m.

Nannen Physical Therapy-636 N 20th Ave. Blair, NE

Name____________________

Address___________________

City______________________

State_____Zip_____________

Phone____________________

Email_____________________

Distance (miles)

 (  ) 20    (  ) 43    (  ) 86   

(  ) 100  --Is this your first century? ______

(  ) 124!!!  --I'M GONNA TRY FOR IT!!!!

Registration fee                 $22     $_______

(Registration for individual is $18 if postmarked before 8/20/12)

Registration-family   $38              $ ______

Registration fee Ages 65   $18    $______

                                     T-shirt (order by 8/1)    $5     $ ______ 

Join BBC (optional)   $10            $ ______

              Total submitted:      $____________

T-Shirt size (must register by 9/1 to get a shirt on 9/8)  

(  )S  (  )M  (  )L  (  )XL  (  )XXL (add $2)