Rider Limit: 2,000 (Refund to all above 2,000). No other refunds given.
Name _________________________________________________________
Phone (_______)__________________
Address ______________________________________________________
City _______________________________________ State __________
Zip________________________
Adult Child (16 or younger)
Early Bird (postmarked by than June 1, 1996) $15 $10 $_________
Regular (postmarked by June 25, 1996) $18 $10 $_________
Day of Ride (if space is available) $20 $10 $_________
AABTS member discount
(if postmarked by June 25, 1996) -1 -1 $_________
Please Reserve My Official 1996 OHR T-shirt.
(T-Shirts are limited so order early.)
(circle size and write quantity @ $10.00 ea.
xs____, sm____, med____, lg____, xl____, xxl____ $_________
Total Enclosed $_________
I expect to ride the ___15-mile ___40-mile ___54-mile
(check one)
___73-mile ___100 mile
The undersigned assumes all responsibility for and all risk of damage or injury that may occur to the undersigned as a participant in the One Helluva Ride or any activities associated there with. I also hereby consent to and permit emergency treatment in the event of injury or illness.
I, the undersigned recognize that the AABTS (Ann Arbor Bicycle Touring Society) is not responsible for the condition of the highways, roads, or biking trails; or for the actions of other drivers, traffic, other bicyclists, pedestrians or obstructions along the roads and trails. If an accident occurs, the question of liability shall be between the undersigned and the third party involved, if any; not with the AABTS or its leaders. I shall abide by traffic laws and regulations and practice courtesy and safety in cycling.
In consideration of being accepted as a participant, I, the undersigned, hereby release discharge and agree to hold harmless the AABTS, the League of American Wheelmen, and all their officers, directors, members and all other agents from all claims, demands, anticipated or unanticipated, and resulting from or arising out of , or incident to, the undersigned's participation in this activity, even from those claims of the AABTS's negligence of its leaders.
I have read and understood, and I agree to, the foregoing Assumption of Risk Agreement and Liability Release, this________ day of ______________________,1996.
Signature of Entrant
_______________________________________________________ Date ___________
Signature of Parent/Guardian if entrant is under 18
_______________________________________________________ Date ___________
Check List: