Randonneurs  USA

Colorado Front Range Flèche
"Vive la Différence!"
Rocky Mountain Cycling Club
Randonneurs USA

Rocky Mountain Cycling Club

ENTRY FORM - 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)


Name ___________________________________________________

Address ___________________________________________________

City _____________________ State/Prov. _________ ZIP/Postal Code ____________

Telephone (day) ___________________ (eve) _____________________   E-Mail _______________________

Club Affiliation _____________________________________________ Age _____

 
Other Riders

Name

Age

Club Affiliation

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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