Saturday, May 17, 2008 -- Winfield, WV / Putnam County Courthouse
Putnam County Bridge to Ridge Bicycle Tour
Make checks payable to/mail to: Winfield Lions Club, P. O. Box 353, Winfield, WV 25213
Proceeds to benefit the Winfield Lions Community Projects.
PLEASE PRINT (One person per form. Copy extras as necessary. )
Name:________________________________________________________________________
(First // Last)
Address (Street/City/State/Zip):_____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Phone: (__________________)_________________________________________
Email:______________________________________________________________
Ride: (Check One Only) 36 Miles____ 62 Miles______ 100 Miles______
IMPORTANT: This is a legal document, please read and understand before signing.
Liability Waiver Required: I, the undersigned, freely acknowledge and realize the dangers of participating in the Putnam County Bridge to Ridge Bicycle Ride and fully assume all risks including, but not limited to, collision with pedestrians, vehicles, other riders, and/or fixed or moving objects, the negligence of 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/or mental trauma (or injury). I understand that the route requires bicycling on public roads and streets and in bad weather cyclists have been hospitalized and/or killed because of traffic mishaps that are either their responsibility or other's responsibility. I further agree that I will bear all expenses incurred in any such accidents. I realize that participating requires an appropriate level of physical conditioning for the ride I choose. I represent that I am in sound medical condition and I have no physical or medical impediment which would endanger myself or others. I understand and agree that a situation may arise during the Putnam County Bridge to Ridge Bicycle Ride which may be beyond the control of the sponsors, promoters, or organizers and agree to ride as not to endanger either myself or others. I will wear an ANSI or SNELL certified helmet when riding a bike during the Putnam County Bridge to Ridge Bicycle Ride. I will obey all West Virginia traffic laws and regulations. If I voluntarily leave the route, I am no longer a part of the ride. 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, promoters or organizers of the Putnam County Bridge to Ridge Bicycle Ride, or other 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 the Putnam County Bridge to Ridge Bicycle Ride. The above agreements and representations are my express understanding 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 and agree to abide by the rules of the Putnam County Bridge to Ridge Bicycle Ride relating to wearing a helmet, riding single file, wearing an identification tag, as well as other organization requirements.
Signature_______________________________________________________________________
(*If entrant is under 18, signature of parent or guardian is required.)
Date:_______________________________
Emergency Contact/Phone: _______________________________________________________