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out, then fill it out and return it to the address at the
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Statement of Release
In consideration of the acceptance of this application for the above event by the Joliet Bicycle Club, Inc., I hereby waive, release and discharge any and all claims for damages for personal injury, death or property damage which I may have, or which may hereafter accrue to me as a result of my participation in this club ride. This release is intended to discharge in advance, the Joliet Bicycle Club, Inc., the promoters, sponsors, officials and any involved municipalities or other public entities (and the respective agents and employees) from and against any and all liability arising out of or connected in any way with my participation in any and all club activities and events, even though the liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.
I further understand that serious accidents occasionally occur during bicycling events and that participants in bicycling events occasionally sustain serious or mortal injuries and/or property damage as a consequence thereof. Knowing the risks of participating in bicycling events, I hereby agree to assume those risks and to release and hold harmless all of the persons mentioned above who might other wise be liable to me for damages.
It is further understood and agreed that this waiver, release and assumption risk is binding on my heirs and assigns. I attest and verify that I am a capable, experienced and physically fit bicyclist and prepared to participate in this Joliet Bicycle Club, Inc. event. I understand that although the organizers of all Joliet Bicycle Club, Inc. events and activities have exercised care to promote the safety of the participants, there are factors present (including traffic, other bicyclists, weather, road conditions, animals, etc.) whose action and conditions are beyond their control. I agree to ride in a cautious and prudent manner and obey all traffic and other laws. I further agree that I will supervise and accompany any and all minor children for whom I have co-signed.
Signature:____________________________________ Age:______ Date:____________
(Participant/Parent or Guardian if under 18)
Responsible participating adult for rider under 18:______________________
Registration Fees:
(make checks payable to: Joliet Bicycle Club
| Adult 7 day tour - Early Early Bird Special
(before April 1st)
Children (12 and under) or non-rider |
$260
$160 |
|
| Adult 7 day tour - Early Bird Special
(before July 1st)
Children (12 and under) or non-rider |
$290
$190 |
|
| Adult Fee 7 day tour - (after June 30th)
Children (12 and under) or non-rider |
$330
$230 |
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| League of Illinois Bicyclists A.I.B.R. is sponsored by the League of Illinois Bicyclists, a state-wide cycling advocacy organization. Your additional tax-deductible donation would be greatly appreciated. Amount enclosed -- $______ For additional information: http://www.bikeLIB.org/ |
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| Total amount enclosed | $_______ |
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Registration Information |
| Name:_______________________________________________ |
| Address:______________________________________________ |
| City:_________________________________________________ |
| State:______________ Zip:_________ |
| Day Phone: ( ) |
| Evening Phone: ( ) |
| E-mail address:____ |
|
Emergency Contact |
| Name:_______________________________________________ |
| Address: (if different from above)___________________________ |
| City:_________________________________________________ |
| State:______________ Zip:_________ |
| Phone: ( ) |
| SHIRT SIZE (circle one): XS S M L XL XXL |
Please advise of any dietary restrictions.
Print, sign and mail this application with a large self-addressed
stamped envelope to:
AIBR 2007
Joliet Bicycle Club
P.O. Box 2758
Joliet, IL 60434