York 38 Special and Spirit of 76
Saturday, August 28, 2010 ---Spirit of 76 Start 6:30 AM---38 Special Start 7-9 AM
To enter, complete this form and return it along with your check or money order payable to York Volunteer Fire Department. One rider per form please. Pre-registration deadline- postmarked by August 14, 2010. Registration is open until 9AM August 28, 2010 at York Fire Hall
Save $$$- Register Early!
Please print legibly
| Last Name | First Name | Age | Gender |
| Address | |||
| City | State | Zip Code | |
| Phone-Daytime: Evening: | |||
Emergency contact-Please list someone NOT on the ride
| Name | Relationship | Phone |
Registration Fees (please check appropriate boxes). Your registration fee includes: T-shirt, Bag, Lunch at York Bar, and all rest stop refreshments.
| ( ) York 38 Special Fee.......................................................................................................................................................$40.00 | $ |
| ( ) York Spirit of 76 (Cyclocross) fee ............................................................................................................................................................$40.00 | $ |
| ( )Late Fee (must be included with registration fee if registering after August 14, 2010..........................$15.00 | $ |
| TOTAL........Check or money order PAYABLE TO: YORK VOLUNTEER FIRE DEPT. (York VFD) | $ |
Check for appropriate T-shirt size (adult) Small ( ) Medium ( ) Large( ) X-Large( )
Representation and Acknowledgement: I hereby represent that I am in good physical condition for this ride. I understand the route is challenging and not chosen for its safety. I understand that this is a non-competitive event and not a race. I further represent I have the ability and equipment to handle the route and any weather conditions. I agree to wear an ANSI approved bicycle helmet, and I understand a rear view mirror is recommended.
Release from Liability: In consideration of the acceptance of the registration by signing this release (parent or guardian if registrant is under 18 years of age) I hereby release for myself and my kin, and waive any claims of action against the York Fire Service Area, its officers, directors, members, agents, and all other persons or entities from all liability arising out of any injury to person or property, and any loss, damage or expenses arising out of any participation in this ride.
APPLICATION IS NOT VALID WITHOUT SIGNATURE!
____________________________________________________ _________________________________________________________ _________________
Signature of Participant Signature of parent or guardian if rider is under 18 Date
Mail completed form and payment to:
York 38 Special, c/o York VFD, 6042 Nelson Road, Helena, MT 59602