Content copyright . Ed Self. All rights reserved.
2011 Cowboys Days "Hale on Wheels" Bike Ride and "Hale On Feet" 5 K Run Registration
SEPTEMBER 17, 2011
ITS A HALE OF A RIDE AND RUN!
ALL PRE-REGISTERED CYCLISTS ARE ELIGIBLE FOR CASH PRIZE DRAWINGS FOR $450.00
PRE-REGISTRATION CLOSES AT 5:00 P. M. ON SEPTEMBER 13, 2011
Pre-Registration fee $25.00 per cyclist if postmarked by September 13, 2011.
Fee $30.00 per cyclist after 9-13-2011.
Family discount (two or more cyclists from the same household)
Fee $20.00 per person if pre-registered. No discount after 9-13-2011.
Cycle Club discount (two or more cyclists from same cycling club)
Fee $20.00 per person if pre-registered. No discount after 9-13-2011.
Fee for 5K runners $20.00.
Please PRINT: Route: ( 21, 32, 48, or 62 miles or 5K run)
NAME:_______________________AGE:___________ROUTE:_____________Gender___M____F
NAME:_______________________AGE:___________ROUTE:_____________Gender___M____F
NAME:_______________________AGE:___________ROUTE:_____________Gender___M____F
Address:____________________________________City:________________________
Home Phone:________________________________Email:_______________________
Emergency contact:___________________________Phone for emergency:__________
If family discount applies, address of household:___________________________________________________
If cycle club discount applies, Name of Cycle Club:_____________________________________________________
T-shirt sizes and number of shirts: S____ M____ L____ XL_____ XXL________
WAIVER (Must be signed by all riders/runners or parent or guardian for rider/runner under 18 years of age)
The undersigned assumes full responsibility for any injury or accident which may occur
during the Cowboy Days "Hale on Wheels" bicycle ride and "Hale on Feet" 5k run. The undersigned hereby releases, holds harmless, and indemnifies the sponsors, promoters, and all other persons and entities associated with this event from any and all liability for any and all injuries and damages
sustained by the undersigned or their child or ward before, during, and after the named event.
If riding, the undersigned acknowledges they will each wear an ANSI, Snell, or ASTM approved bicycle
helmet during the event. The undersigned acknowledges they are each familiar with the
dangers involved in the event, that there may be dangers in or on the riding/running surface, and
that there will be vehicle traffic on the roads upon which the ride/run will take place. The
undersigned each acknowledges that they will obey all laws during the event. Each of the undersigned acknowledges that they are in good physical condition and able to participate in the event.
Signature:_______________________________________Date:______________________
Signature:_______________________________________Date:______________________
Signature:_______________________________________Date:______________________
