REGISTER for MassBike Tour '98
___ I will ride the entire Tour: Sun-Sat, July 19-25
___ Member ($375) ___ Non-member ($395)
___ I will ride the MiniTour only: Sunday, July 19
___ Member ($30) ___ Non-member ($35)
___ I will ride the WWW.century only: Wednesday, July 22
___ Member ($40) ___ Non-member ($45)
All proceeds benefit the advocacy work of MassBike.
COMPLETE personal information
Name ______________________________ Age ______
Address ______________________________________
City _____________________ State ____ Zip _______
Home Phone _____________________
E-mail _________________________
Emergency Contact _______________________________
Emergency Phone _________________________________
INDICATE preferences
___ As part of entire Tour, I plan to ride the WWW.century
___ I prefer vegetarian meals.
T-shirt size: ___ Med. ___ Large ___ X-Large
JOIN MassBike/RENEW membership
Memberships available at the following annual rates (select one):
___ $30 Regular
___ $40 Family (two memb cards)
___ $50 Premium (free gift)
___ $75 Contributor
___ $100 Sponsor
___ $250 Benefactor
CHOOSE a gift with $50+ membership
As a special thanks for joining at $50 or more, select your gift:
Bicycle Map:
___ Boston, incl. Minuteman Bikeway
___ MetroWest
___ Cape Ann/Cape Cod
___ Eastern Massachusetts
___ Western Massachusetts
Or...
___ Waterbottle, 28 oz. ___ NO GIFT
SUBSCRIBE to The Ride magazine
MassBike members can subscribe to The Ride magazine at half-price ($7.50
extra) for the duration of their membership
PAYMENT
TOUR Registration (from above) $ ______
MassBike membership $ ______
SUBSCRIPTION to The Ride ($7.50) $ ______
TOTAL AMOUNT: $ ______
METHOD of payment (select one):
___ Check Make check(s) payable to "MassBike".
___ MasterCard/VISA Fill out your credit card information.
credit card number: _______________________________
expiration date: __________________________________
signature: ______________________________________
READ and SIGN Liability Waiver
IN CONSIDERATION of being permitted to participate in any way in MassBike
Tour '98 ("Activity") I, for myself, my personal representatives,
assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (C) THERE MAY BE OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the Massachusetts Bicycle Coalition, their respective administrators, directors, agents, officer, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OR RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
I HAVE READ THIS AGREEMENT, FULLY AND UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTEND ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
_________________________________________ Participant's Signature _________________________________________ Printed Name _________________________________________ Date _________________________________________ Signature & Parent or Guardian (for riders under 18)