SUNDAY
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..
For more information, call Ellen Haver at 209-838-1435, e-mail Marilyn Lindberg at ldbgsprt@aol.com or visit our WEBSITE at www.mantecabicycleclub.org.
HELMETS ARE MANDATORY.