To register for Bike to Work Day, Tuesday May 18, 1999, print out and fill out this form and return it to either your corporate challenge coordinator, or to Adam Shulman, Boston Bicycle Festival, Boston Transportation Department, City Hall, Room 721, Boston, MA 02201 (fax 617-635-4295). All registrations are due by May 18, 1999. Each company should submit a form, too. I pledge to bike to work: Please Print Name: _________________________________________________________________ Address: ______________________________________________________________ City/Town: __________________________________ Zip: ___________________ Daytime Phone: ________________________________________________________ Employer: _____________________________________________________________ How do you regularly commute?__________________________________________ I am commuting from_____________________________(neighborhood/city) Note: Please be specific: Back Bay, South End, Coolidge Corner, Brighton Center, Kenmore Sq. I am commuting to_________________________________(Company name and location) How many miles is your commute, round-trip? _______________________ How many days a week do you bike to work? _______________________ ___ I am interested in leading a group from my neighborhood. ___ I am interested in joining someone from my neighborhood. ___ I plan to attend the Boston Bike Festival, Friday May 21, 1999. ___ Please register me in the Bike Festival Raffle. I hereby assume all risks inherent in any physical activity and release and hold harmless any event organizers, and their employers of any and all claims and liabilities arising from participation in this event. I have full knowledge of the risks involved and am fit to participate in this event. Signature: _____________________________________ Date:____________________ For information call the Bike Festival Hot line: 617-635-2075