T-shirt size: Medium Large X-Large XX-Large
(NOTE: T-shirt may not be available on day of
ride it not ordered by 9/27/00)
Amount Enclosed: $20.00 if postmarked by 9/27/00 $25.00 after 9/27/00
All riders will be required to wear helmets!
RELEASE Please read carefully and sign.
In consideration of the
acceptance of this application, I hereby, for myself, my heirs, executors, administrators
and assigns, and anyone entitled to act on my behalf, release and discharge the
Chattanooga Bicycle Club, plus sponsors, their representatives and successors, directors,
officials, employees and volunteers, from any and all claims of injury or damages suffered
by me as a result of my participation in or traveling to or from the Chattanooga Bicycle
Club Two-for-One Century.
I know that bicycle riding is potentially
hazardous. I should not enter the Chattanooga Bicycle Club Two-for-One Century unless I am
medically able and properly trained. I assume all risks associated with riding in the
Chattanooga Bicycle Club Two-for-One Century, including but not limited to, falls, contact
with other participants, the effect of the weather, traffic, and conditions of the road,
all such risks being known and appreciated by me. I realize that bicycling is a strenuous
activity which requires proper physical conditioning. I hereby certify that I am in such
physical condition and good health.
Signature ______________________________________ Date
Signature of Parent or Guardian if under 18 _______________________Date
(Must be accompanied by adult if under age 16.)
Please fill out and print the form, read & sign the
release. Make checks payable to: CHATTANOOGA BICYCLE CLUB Send to: Chattanooga Bicycle Club
attn: century
PO Box 11495
Chattanooga, TN 37401
