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.
BLAIR BIKE CLUB
636 N 20TH AVE
Blair, NE 68008
Proceeds to be donated.
This Cool Art (above) on River Ride T-Shirt!
BBC Rollin to the River Century 100
FIFTH ANNUAL!
Entry Form
August 6, 2011 @ 7:30 a.m. Nannen Physical Therapy-636 N 20th Ave. Blair, NE
Name____________________
Address___________________
City______________________
State_____Zip_____________
Phone____________________
Email_____________________
Distance (miles)
( ) 20 ( ) 36 ( ) 56 ( ) 68
( ) 100 --Is this your first century? ______
Registration fee $22 $_______
(Registration for individual is $18 if postmarked before 7/20/11)
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 8/1 to get a shirt on 8/6)
( )S ( )M ( )L ( )XL ( )XXL (add $2)
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
Consider joining the BBC!
We offer: Club Rides... Summer Time Trials... Bowling events, etc, etc!!!