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BIG RACCOON CREEK BIKE TOUR REGISTRATION FORM

October 25th 2003

Waiver: I know that biking is a sport that can result in harm. Helmets must be worn. I understand that the Bridgeton Bike Tour is carried out on public roads and public property with no traffic control. In signing this release I understand and agree to indemnify and hold harmless all of the sponsors and organizers singly and collectively from all claims of damages, injury or death resulting from my participation in this Bike Tour. If I am a parent or guardian of a minor entrant I agree to indemnify and hold harmless sponsors and organizers of all claims of damages, injury or death which said minor may sustain. I consent to emergency treatment for myself or minor. THOSE UNDER 18 MUST HAVE A PARENT OR GUARDIAN SIGN THE RELEASE.

REGISTRATION FORM - PLEASE PRINT
NAME:  i
ADDRESS:  i
PHONE:  i
EMERGENCY CONTACT:  i
DATE: 
FEE: $10 IF PRE REGISTERED BEFORE October 20, then $15 CHECKS PAYABLE TO: Friends of the Bridgeton Mill Dam
Fee includes marked route, maps, SAG and well-stocked rest stops. REGISTRATION  8:00 - 10:00 AM  AT THE BRIDGETON MILL
Where did you learn about our Bike Tour? Flyer____Internet____Friend____Ind. Bicycle Coalition Mag___Other____________
FEE ENCLOSED $
SIGNATURE  i
MAIL TO:
Sandy Szymaszek
 Friends of the Bridgeton Mill Dam. 
P.O. Box 4, Bridgeton, IN 47836   		For more information
(765) 548-0628 - (765) 548-2136
For Questions E-Mail Sandy Szymaszek sandyszy@webtv.net

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