RAIN registration form

Entry Form for RAIN 2007

If you would like to use this form, please type in the required information, print the form using your browser's PRINT function, and mail it to the address below with your check. Make checks payable to RAIN 2007. Don't forget to sign and date the waiver below.

RAIN 2007
c/o Bloomington Bicycle Club
P.O. Box 463
Bloomington, IN 47402-0463

Name M/F Age

Address

City State Zip

Phone number E-mail address

Emergency contact name Emergency contact phone number

First time entry?

T-shirt size (t-shirt is included with registrations received by July 10) S M L XL XXL

1. Rider fee: $40.00 per rider until June 14; $50 thereafter

2. Extra rider t-shirts: (enter the number desired in box; $15.00 at event)

M L XL XXL

Total x $13.00 each = ($15.00 at event)

3. Support crew t-shirts

M L X XXL

Total x $13.00 each = ($15.00 at event)

4. Extra meal tickets for support crew (lunch stop only; enter number desired in box)

Total x $5.00 each=

5. Short-sleeved jersey by Revi (enter the number desired in box)

S M L XL XXL

Total x $60.00 each =

6. Sleeveless jersey by Revi (if ordered by May 1) (enter the number desired in box)

S M L XL XXL

Grand total (add totals from 1, 2, 3, 4, 5, and 6):

THIS RELEASE MUST BE SIGNED AND DATED, OR YOUR ENTRY WILL BE RETURNED.
I, the undersigned, freely acknowledge and realize the dangers of participation in RAIN 2007 and fully assume all risks including, but not limited to, collision with pedestrians, vehicles, other riders, and/or fixed or moving vehicles, other riders, sponsors, promoters, or drivers, and dangers arising from falls, road surface, equipment failure, inadequate safety equipment, weather conditions, as well as the possibility of physical and mental trauma. I understand that the route requires bicycling on public roadways and in bad weather and that cyclists have been hospitalized and killed because of traffic mishaps that are either their responsibility or others responsibility and I further agree that I will bear all expenses incurred in any such accidents. I realize that RAIN 2007 requires physical conditioning and I represent that I am in sound medical condition. I have no physical or medical impediments which would endanger myself or others. I understand and agree that a situation may arise during RAIN 2007 which may be beyond the control of the sponsors, promoters or organizers and agree to ride so as not to endanger either myself or others. I waive, release, discharge for myself, my heirs, executors, administrators, legal representatives (including successors), any and all rights and/or claims which I have, may have or may hereafter accrue to me against the sponsors and promoters of RAIN 2005 including Earlham College and Bloomington Bicycle Club or their sponsors or affiliated organizations and their respective agents, officers and employees for any and all damages, injuries or claims which may be sustained by me directly or indirectly arising out of my participation in RAIN 2007. The above agreements and representations are my express understandings of the risks and I assume these voluntarily and freely without coercion or duress. This agreement may not be modified orally and may not be waived in any respect. I accept responsibility for the condition and adequacy of my bicycle, will wear a helmet as required, and will carry water and personal identification at all times, and agree to abide by the rules of RAIN 2007. Sign and date the release below. In the case of a minor, the parent/legal guardian must sign and date the release. If not properly signed, your entry will be returned.
SIGNED (Guardian if under 18) : _______________________________________ DATED: ____________________

THIS RELEASE MUST BE SIGNED AND DATED, OR YOUR ENTRY WILL BE RETURNED.

I, the undersigned, freely acknowledge and realize the dangers of participation in RAIN 2007 and fully assume all risks including, but not limited to, collision with pedestrians, vehicles, other riders, and/or fixed or moving vehicles, other riders, sponsors, promoters, or drivers, and dangers arising from falls, road surface, equipment failure, inadequate safety equipment, weather conditions, as well as the possibility of physical and mental trauma. I understand that the route requires bicycling on public roadways and in bad weather and that cyclists have been hospitalized and killed because of traffic mishaps that are either their responsibility or others responsibility and I further agree that I will bear all expenses incurred in any such accidents.

I realize that RAIN 2007 requires physical conditioning and I represent that I am in sound medical condition. I have no physical or medical impediments which would endanger myself or others. I understand and agree that a situation may arise during RAIN 2007 which may be beyond the control of the sponsors, promoters or organizers and agree to ride so as not to endanger either myself or others.

I waive, release, discharge for myself, my heirs, executors, administrators, legal representatives (including successors), any and all rights and/or claims which I have, may have or may hereafter accrue to me against the sponsors and promoters of RAIN 2005 including Earlham College and Bloomington Bicycle Club or their sponsors or affiliated organizations and their respective agents, officers and employees for any and all damages, injuries or claims which may be sustained by me directly or indirectly arising out of my participation in RAIN 2007. The above agreements and representations are my express understandings of the risks and I assume these voluntarily and freely without coercion or duress. This agreement may not be modified orally and may not be waived in any respect. I accept responsibility for the condition and adequacy of my bicycle, will wear a helmet as required, and will carry water and personal identification at all times, and agree to abide by the rules of RAIN 2007.

Sign and date the release below. In the case of a minor, the parent/legal guardian must sign and date the release. If not properly signed, your entry will be returned.

SIGNED (Guardian if under 18) : _______________________________________ DATED: ____________________