REGISTER
Name:
Address:
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, City of Harrodsburg, Harrodsburg Community Center, The Grace Center, 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:
All credit card payments are received on line through Pay Pal, a reputable and secure payment center. No entity or individual is given access to your credit card information other than Pay Pal - not even Energy2Action. Please note that you will be charged $1 for processing through PayPal.
THE POPCORN ROAD RIDE
Bicycle Touring Event
15, 30, 55 and 100 Mile routes
September 1, 2012
9:00 a.m.
Entry Fee
$25.00 No Shirt
$40.00 With Long Sleeve Shirt
$90.00 With Short Sleeve Cycling Jersey
Pre-registration ends on 8/25/12
Event Day Registration
$30.00
(Shirts and Jerseys not guaranteed to race day sign ups)
Event Day Registration begins at 7:30 a.m.
Harrodsburg Community Center
1005 W. Popcorn Rd.
Harrodsburg, IN 47434
(10 Miles South of Bloomington on ST. Rd. 37)
T-Shirt: ($15 extra)
Want a MAIL IN REGISTRATION instead?
Riders are not obligated to complete the distance indicated here. This is for information in planning only. Keep in mind SAG service is not guaranteed after 3:00 p.m.
Anticipated Distance:
Cycling Jersey:
($69 extra)
Check THE SIZING CHART
If you purchase a jersey that is "out of stock" it will be mailed to your address 4-6 weeks after the ride
