Bike-n-Brunch 2017: Jun 4, 2017

WRHC BikeNBrunch

Bike N Brunch Form

                                                   WRHC Bike-N-Brunch
                                                  15-30-45 Miles Routes
                                            Farm to Table Gourmet Brunch

Date: Sunday, June 4, 2017

Registration 8:30, Ride 9:00 am est. Ride will depart from 10232 Wilson Road, New Buffalo MI 49117, 2 miles east of Four Winds Casino. Address/map provided with registration.

 Please register by June 3, 2017.

 Registration /waiver forms are required for each rider. Forms may be duplicated.

 Ride is limited to first 100 registrants, Adults - $50, Kids under 12 - $30

 Register via Paypal or credit card on our website http://www.radioharborcountry.org or...  Mail check payable to WRHC, P.O. Box 101, Three Oaks MI 49128

 Ride occurs rain or shine.

 Bike-n-Brunch communications: bikenbrunch.wrhc@gmail.com , Ph: 815-341-5919

__________________________________________________________________________________________________ Last Name First Name

__________________________________________________________________________________________________ Address City State Zip

__________________________________________________________________________________________________ Home Phone Work Phone Cell Phone

__________________________________________________________________________________________________ E-Mail (REQUIRED) Birthdate Emergency Contact Name and Phone

FORM OF PAYMENT: Cash 🀆 Check 🀆 Paypal 🀆 or Credit card on website 🀆

Please do not include my photo for future WRHC promos 🀆

In registering for the WRHC 2017 Bike-N-Brunch:  I agree to ride safely, signal my movements, be alert to my surroundings, stay to the right when riding slowly and pass on the left of other participants.  I agree to obey the rules and directions of the ride’s organizers and volunteers. This includes wearing a helmet during the ride.  I understand that bicycling involves risks and can result in loss of personal property, bodily injury or even death.  I personally assume any and all of the risks associated with participation in this event, and I release, absolve, indemnify and hold harmless WRHC and all of their directors, officers, sponsors and volunteers from any manner of liability, claims for damages or causes of action.  IF REGISTERING A MINOR(S), I affirm that I am the custodial parent or legal guardian of the minor. I consent to the above terms, including the waiver and release of claims, on behalf of the minor(s). I affirm I have the authority to grant such consent, and I agree to supervise the minor(s) and ensure that the above terms are followed by the minor(s).

Participant’s Signature (Parent , if minor) _______________________________________________________________ date

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