RRmailinregistration

The Popcorn Road Ride

Saturday, September 1, 2012

Bicycle Touring Event

9:00 a.m.

Start: Harrodsburg Community Center

1005 W. Popcorn Rd.

Harrodsburg, IN 47434

MAIL IN REGISTRATIONS DUE BY August 25, 2012

$25.00 No Shirt

T-Shirts are $15.00 Extra

Jerseys are $69.00 Extra

PRINT, FILL OUT AND MAIL TO:

Energy2Action, LLC

1223 Oak Lane

Shelbyville, IN 46176

Name:

Address:

City:

State:

Phone:

E-mail:

Zip:

Male

Female

Signature:

T-Shirt Size:

Age on event day

Back

Make Checks Payable to: Energy2Action, LLC

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.

Anticipated Distance:

Riders are not obligated to complete the distance indicated here. This is for information in planning only. Keep in mind the course and lunch stop closes at 3:00 p.m.

Cycling Jersey Size:

Jerseys are European Sizes - check 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