JUNE 10th, 2001
MANTECA BICYCLE CLUB
PO BOX 205
MANTECA CA 95336
Name(s): _________________________________________________ Age(s): __________________
Street Address: ____________________________City: _______________ State: _____ Zip: _________
Phone Number: (___) __________________ Emergency Phone Number: (___) ____________________
Email Address: _________________________
Number of Riders: 30 Miles ______ 100K ______ 100 Miles _______
(Checks payable to Manteca Bicycle Club, Mail To PO Box 205, Manteca CA 95336)
This Form may be Duplicated. Multiple riders can be on the same form if we have all names and signatures.
In consideration of acceptance of this entry or of my being permitted to take part in this event, I, for myself, my heirs, executors, administrator, successors, and assigns, waive, release and discharge all claims for damages resulting from death, personal injury or property damage which I may have, or which may hereafter accrue to me as a result of my participation in this event. I understand this release is intended to discharge and release, in advance, the Manteca Bicycle Club, its members and their respective agents, officers, officials, servants and representatives, and any involved municipalities and their respective agents and employees from and against any and all liability arising out of or connected in any way with my participation in the event, even though that liability may arise out of negligence or carelessness on the part of persons or entities mentioned above.
I further understand that serious accidents occasionally occur during bicycle events and that participation in such events as the Crossroads of California occasionally sustain serious personal injury, death and/or property damage as a consequence of that participation. Nevertheless, knowing the risks of bicycle events, I, for myself, my heirs, executors, administrator, successors, and assigns hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who, through their negligence or carelessness, might otherwise be liable to me for damages.
I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract btween myself and the Manteca Bicycle Club and sign it of my own free will.
Signed: _______________________- Printed Name; ______________________________
Parent must sign if participant is under 18 years of age.
The registration fee covers SAG, a PATCH, rest stop SNACKS, and LUNCH at the end of the ride.
The ride starts at Lincoln Park which is on Powers Avenue off of Yosemite. From Highway 99, take Yosemite Avenue exit and head West. Turn left on Powers, past FOOD4LESS. From Interstate 5, take the 120 bypass EAST to Main Street. Turn left or North to Yosemite. Turn right and Yosemite then right on Powers, past Lincoln School..
HELMETS ARE MANDATORY.