Name:
Address:
City:
State:
Phone:
E-mail:
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Zip:
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, Brown County State Park and Energy2Action, LLC, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this cycling event may expose me to dangers from both known and anticipated risks. I understand that the course is not closed to traffic and that I could be at risk from traffic, other cyclists, bad weather, and rough terrain along the course. I acknowledge that some sections of this bike course may contain rough road and may contain areas where I will be at risk of falling or wrecking on my bike. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Age on Event Day:
Riders are not obligated to complete the distance indicated here. This is for information for our planning only. Keep in mind the course and lunch stop closes at 3:00 p.m.
Anticipated Distance:
THE GOAT RIDE
Saturday, August 13, 2016
8:00 A.M.
Touring Bicycle Ride
12-25-34-45 MILE ROUTES
Mail In Registration
Print, complete and mail to:
Energy2Action, LLC
1223 Oak Lane
Shelbyville, IN 46176
$30.00 Individuals Pre-Registration
(includes cool "Goat" coffee mug and lunch)
Pre-registration is due by
August 7, 2016
Event Day Registration:
$35.00 Individuals
"Goat" coffee mugs may not be available to event day sign ups!
Event Day Registration opens at 6:30 a.m.
Signature:_________________________________
Printed:___________________________________
Date:____________________
Goat Ride: $30.00 (Must be received by 8/7/16
Goat T-Shirt: $20.00
Total Enclosed:
