Registration
MAIL ENTRY FORM & CHECK OR MONEY ORDER TO: Hamilton General Hospital, 400 North Brown, Hamilton, TX 76531 Attention: Lee Ann Lee
Last Name: _______________ First Name: _____________ Mailing Address: _______________
City:____________________________ State:______________________ Zip: _____________
Phone: (include area code): Home: ______________Work: ______________ E-Mail:_______________
T-SHIRT SIZE: ADULT: S__ M __ L __ XL __ XXL __ CHILD: S __ M __ L __
RIDE LENGTH: 10K __ 20 Mile __ 30 Mile __ 46 Mile __ 61 Mile __ 79 Mile __ tandem __ Child___
(Important-Please specify length)
THIS WAIVER OF CLAIM MUST BE SIGNED. In consideration of the acceptance of this registration entry, I, the undersigned, assume full and complete responsibility for any injury or accident which may occur during my participation in the Hamilton Hill-Aceous 100, and I hereby release and hold harmless the sponsor, promoters and all other persons and entities associated with this event, from all and any injury or damages, whether it be caused by myself or the negligence of the sponsor, promoters, or any other persons associated with the event. This agreement may NOT be modified orally by any individual. I understand that a bicycle is a legal vehicle in the State of Texas and that I must ride in a safe manner consistent with state law and wear an approved helmet.
SIGNATURE OF PARTICIPANT: ________________________________________Date: _________________________________(Signature of parent required if rider is younger than 18)
PLEASE TELL US WHERE YOU LEARNED ABOUT OUR EVENT: this mailout ___ ride website ___ TX Bicycle Coalition ___ local newspaper ___ active.com ___ local bike shop ___ e-mail ___ other ____________________ (please specify)
Photocopies of this form are accepted and welcomed.
