Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Bike Waiver *

In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, administrator and assigns release and discharge Bike4Beds INC, their agents, and sponsors whose facilities, services and products are being used for this event, from any claims for damages suffered by me as a result of my participation in or traveling to or from said event. I specifically release and discharge the said promoters and sponsors and all participants, whose facilities are being used for this event, etc. from all injuries or damages arising from or contributed to any physical impairment or defect I may have, whether latent or patent, and agree that they are under no obligation to provide physical examination or other evidence of any fitness to participate in such event, the same being my responsibility. I also give permission for the free use of my name and picture in any broadcast, telecast or other written account of the event. I understand that helmets are required for riders under the age of 16 and recommended for riders 16 and over. I also understand that there will be regular traffic on these roads and I must adhere to all traffic laws and regulations.

By checking this box, I agree with the above waiver.

By checking this box, I agree I am over sixteen years of age

Birthdate *

You must be over 18 years of age OR the parent/legal guardian of a minor under 18 years of age OR the legal guardian of an incapacitated and/or mentally challenged person in order to agree to the text above. Enter your Birth Date:

MM

DD

YYYY