Colorado
Front Range Flèche
"Vive la
Différence!"
Rocky Mountain
Cycling Club
Randonneurs USA
| |
Colorado
Front Range Flèche | |
| Include: | map and cue sheet, and waiver signed by each team member.
Each team member may mail/e-mail the waiver individually with his/her signature. All team members must have current RMCC membership. |
| Send: | by e-mail an image of this form plus links to other materials, or mail to:
John Lee Ellis, 3936 Dale Drive, Lafayette, CO 80026 |
Note: for tandem participants, list the names and ages of both riders together in one space.
TEAM NAME _____________________________________________
TEAM CAPTAIN (Rider #1)
Address
___________________________________________________
City _____________________ State/Prov. _________
ZIP/Postal Code ____________
Telephone (day) ___________________ (eve)
_____________________ E-Mail _______________________
Club Affiliation
_____________________________________________ Age _____
Name Age Club Affiliation
Name ___________________________________________________
Other Riders
Rider #2
Rider #3
Rider #4 (optional)
Rider #5 (optional)
PROPOSED TIMETABLE (you
must have a departure control point, a 22-hour control and a 24-hour control;
there is no upper limit on the number of control points)
LOCATIONS
departure ______________________________ starting date and time
______________
control point #1 ______________________________ starting time + ______ hours
control point #2 ______________________________ starting time + ______ hours
control point #3 ______________________________ starting time + ______ hours
control point #4 ______________________________ starting time + ______ hours
control point #5 ______________________________ starting time + ______ hours
control point #6 ______________________________ starting time + ______ hours
control point #7 ______________________________ starting time + ______ hours
control point #8 ______________________________ starting time + ______ hours
estimate mileage at 24-hour point __________
Release Form: In signing this release, I acknowledge that I understand its intent, and I for myself, my heirs, executors, administrators, and representatives, do hereby agree and will absolve and hold harmless the Rocky Mountain Cycling Club, Randonneurs USA, and any other parties connected with this event/these events in any way, from and against any blame and liability for any harm, loss, inconvenience or any other damage of any kind whatsoever, which may result from or be connected in any way from my participation in this event/these events.
In addition to the absolute and unqualified release from all liability, I hereby represent that I am physically capable of participated in this event/these events; that my bicycle and any other equipment I may use is in good working condition; that I will observe all applicable traffic and event rules; and that I will wear a helmet and generally conduct myself in a safe and prudent manner while participating in the event(s).
I further agree to abide by the rules for riders of brevets. I certify that I am a member in good standing of the Rocky Mountain Cycling Club, and that I have read this waiver and release and understand its significance.
Participant’s Name
Signature
Date
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