WAIVER (please sign and date) - In signing below, I acknowledge that I understand this waiver’s
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, Ultra-Marathon Cycling Association, 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); that
I undertake this ride as a
personal bike tour and take responsibility for my own safety.
I further agree to abide by the rules for riders of brevets. I certify that I
have read this waiver and release and understand its significance.
Signed (Rider, or Parent/Guardian if Rider is under the age of 18) ___________________________
Date ______________
Payment - by check or money order - is due with this application.
If paying in foreign currency, calculate your US$ amount, including the $10 surcharge,
multiply by the exchange rate, and send that sum. For example, payment of the $150 base fee in Canadian dollars would be (US$150 + $US10) x 1.22 = 195.20 Canadian dollars.
Cancellations by Aug 1: full refund minus $10; Aug: 50%, Sept. 25%.
|
Base Cost Recovery Fee
| $150
| ________
|
RMCC One-Year Membership (optional)
| $25
| ________
|
RMCC Member Discount
| -$15
| ________
|
Foreign-Currency Surcharge
| $10
| ________
|
TOTAL
| US$
| ________
|
|
Make check payable to Rocky Mountain Cycling Club.
Mail to: Rocky Mountain Cycling Club, Last Chance 1200k, P. O. Box 201, Wheat Ridge, CO 80034-0201 USA.