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READ THE RIDE DESCRIPTION AND WARNING BEFORE SIGNING THIS RELEASE!
Please accept my entry in the 3 Mountain Madness bike ride (“the Event”) on June 5, 2010. In consideration of your acceptance of my entry, and intending to be legally bound for myself, my heirs, my executors, and my administrators, I do hereby forever waive, release, and fully discharge any and all claims of any kind whatsoever arising from or as a result of death, personal injury, or property damage which I may have, or which may hereafter accrue to me, as a result of my presence at or participation in the Event. This waiver and release is intended to discharge in all ways and for all time the following: Harry Wilson, Ricky Adkins, and their heirs, agents, executors, all sponsors (and their respective agents, employees, heirs, executors), the Hanging Rock and Pilot Mountain State Parks, the Armfield Civic Center (and their respective agents and employees), and all officials, volunteers, municipalities or public entities (and their respective agents and employees) from and against any and all liabilities of any kind whatsoever arising in, from, during or as a result of the Event. I understand and willingly acknowledge that serious accidents occasionally happen during cycling events and that participants in such events occasionally sustain mortal or serious injuries and/or property damage, as a consequence thereof. Knowing and understanding these risks, nevertheless, I hereby agree to assume those risks and all other risks of any kind whatsoever associated with participating in the Event and I do hereby release and hold harmless all of the persons and entities who might otherwise be liable to me (or to my heirs or assigns) for damages. It is further agreed and understood by me that this waiver, release and assumption or risk is to be binding on all my heirs, executors, and assigns. I also agree and understand that any sponsor may subsequently use for publicity and/or promotional purposes my name and/or picture of me participating in this Event without obligation or liability to me and without the necessity of obtaining any additional permission. I understand that entry fees are nonrefundable. I HAVE READ THE ENTRY FORM INFORMATION PROVIDED AND CERTIFY MY UNDERSTANDING AND COMPLIANCE BY MY SIGNATURE BELOW
Signature of entrant_______________________________________ Date_____________________
Signature of Parent or Guardian if under 18_______________________________________________
REGISTRATION
Name: ______________________________________ Email Address: _______________________________
Phone: (_____)__________________ Route: 41 mile____ 75 mile______ 95 mile______
Age: ______ Sex: M___ F____ T-Shirt Size: S M L XL XXL Number of Extra meals:_______
Emergency Contact: ____________________________Phone: _________________________________
How did you learn about our ride?_________________________________________________________
Do you plan to stay overnight before or after the ride?_______________________
Mail completed registration with check ($40 before 6/2) to: 3 Mountain Madness, C/O Sharon Adkins, 4210 Willow Knoll Lane, Winston-Salem, NC 27106 (Make check payable to "3 Mountain Madness")
** You may register the day of the event for $50 (no t-shirt) if we have not reached our limit. Goodies limited to first 250 to register **