Print Out and Mail (May be Photocopied)
(On-line Registration Available on our Web Page link to Active.com)
STARVED ROCK CYCLING ASSOCIATION
25th PUMPKIN PIE RIDE

Sunday, October 5, 2014$23 by September 18, 2014 by midnight, $30 after September 18, 2014 midnight, children 12 and under $5
Location: Ottawa YMCA, 201 East Jackson St, Ottawa, IL 61350 E-mail: starvedrockcycling@yahoo.com
Riders who register by 9-18-14 Midnight are eligible for door prizes. T-Shirt guaranteed to Pre-Reg. ONLY by 9-18-14 for additional $20, Day of ride shirts are $25. Road Rides - 28, 42, 63, 103 (Light traffic, rolling hills) or I & M Canal Towpath (Flat crushed limestone surface)- Mileage varies. Registration: OPENS 7 am to 10 am (103 mile riders encouraged to start at 7:15 am) All rest stops close 3:00pm. Please plan accordingly. SAG support ends for all riders 3:30pm

No headphones, HELMETS REQUIRED. obey rules of the road. NO REFUNDS

League of American Bicyclists (LAB) RELEASE and waiver of liability, assumption of risk, and indemnity "agreement." In consideration of being permitted to participate in any way in the Starved Rock Cycling Association sponsored bicycling activities, 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 that 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 including but not limited to dogs, wildlife, traffic, or other road conditions. 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 RISK 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 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, Starved Rock Cycling Association, League of American Bicyclists, their respective administrators, directors, members, agents, officers, 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 of 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 a result of such claim.
4. I grant Starved Rock Cycling the right to take photographs of me and my family in connection with this event and agree that Starved Rock Cycling may use photographs with or without names for any lawful purpose (e.g. publicity, illustration, web, or Facebook content). I understand that Starved Rock Cycling does not sell or share demographic information to any other parties for any reason.
5. I agree to cooperate to "share the road" and agree not to ride more than two abreast. I agree to follow all rules of the road, which apply to both cars and bicycles.
6.I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD INVALID THE BALANCE NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT.

_____________________________________________
Signature of Participant (WE DO NOT SHARE OR SELL YOUR DEMOGRAPHIC INFORMATION)

Riders Name (Print Only)

AGE
Signature
Route
(Only One Ride Entry Per Form Please! -- Form May be Photocopied or Print out as Many as you Need.)

 

_____________________

 

______

 

________________________

RD 28/42/ 63/ 103

Optional T-shirt ---S / M/ L / XL/ XXL/ XXXL

Address

City

State

Zip

 _____________________

 _______________

 ____

 _________

Emergency Phone:

Contact Phone:

 _____________________

 ________________________

*If rider is 12 or under, must be accompanied throughout the ride by a guardin or parent.

** Signature of guardian or parent required for riders under 18.

Fees:

Through 9-18-14----After 9-18-14

Amount

Make checks payable to:

Each Rider

$23 ------------------$30

$__________

Starved Rock Cycling Ass'n

PO Box 2304

Children 12 and under

$5--------------------$ 5

$__________

Ottawa, IL 61350

Long Sleeved T-shirt

$20

$__________

Total Enclosed

$__________

Starved Rock Cycling does not share or sell demographic information given on this form.

Directions to Ottawa YMCA: Clip and Save:

From North, East and West:

I-80 to Ottawa Exit #90 (Rt 23)
South on Rt 23 to Jefferson St. (Past Washington Park) turn left
one block to Columbus. Left on Columbus one block to Jackson
St. Turn Right to YMCA

From South:

I-39 to I-80 to Ottawa Exit #90 (Same as above);
or from Route 23 cross over the Illinois River. Rt 23 becomes
Columbus St.Turn right on Jackson St. (4th stoplight) and
proceed to the YMCA.