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Andy Jordan's Bicycle Warehouse
706-724-2453
M-F 10a-6p
Sat 10a-4p

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Lock to Lock Ride - Registration Form

Sunday, May 21st, 2017

 

Please Read and Sign Below

I hereby release and agree to hold harmless the promoters, owners, and lessees of the premises, participants, officers, officials, representatives’ agents, and employees of all of them, of and from all liability, loss claims and demands that may accrue from any loss, damage or injury (including death) to my person or property, in any way resulting from or arising in connection with this event, and whether arising while engaged in competition or in practice or any cause whatsoever. I know the risk and danger to myself and property while upon said premises or while participating or assisting in this event, so voluntarily and in reliance upon my own judgment and ability, and I hereby assume all risk for loss, damages or injury (including death) and my property from causes whatsoever. I also understand that the registration fee is non-refundable after Tuesday, May 16, 2017.

                                     ALL RIDERS MUST WEAR A HELMET
Rider Signature ________________________________Date___________
Signature of parent/guardian if under 18 ___________________________

Please Print Information Clearly

Rider Name_____________________________________DOB___________

Street Address___________________________________

City/State/Zip____________________________________

Phone Number_____________________
Email Address______________________________________

Emergency contact name and phone # __________________________________
Circle T-Shirt Size (size not guaranteed) - XS  SM  MD  LG  XL  XXL
Check Ride Option - 18.5 mi___37 mi___
-------------------------------------------------------------------------------------------------------------------
Pre-Registration is $25
and must be received by Thursday, May 18th at 6PM
Make checks payable to: NTD  (National Trails Day)
Day of Event Registration $35
All net proceeds benefit local bicycling improvement efforts.

Mail to or drop off at:
Andy Jordan's Bicycle Warehouse
Lock to Lock Ride
527 13th St.
Augusta, GA 30901