Another Bloomin' Bike Ride – March 22, 2008
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Name:_____________________________________Age:____ Address:___________________________________________ City: Phone:___________________ E-mail___________________ |
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No. of T-Shirts: ___ S ___ M ___ L ___ XL ___ XXL Route Options: (Circle One) 25 62 |
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Total Number of T-Shirts ($12 each).......................$________ 25 Mile Ride($25.00*)..............................................$________ 62 Mile Ride($25.00*)..............................................$________ I am unable to attend, but want to make a donation $________
*Fee includes t-shirt. |
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Statement of Release I, the undersigned individual, do hereby release the cities through which this ride travels, the Kiwanis Club, its officers, sponsors, support personnel, and organizers of all responsibility and blame for injury, harm, loss, or inconvenience to myself and/or the named participant(s) under age of 18 for whom I am a parent or guardian, as a result of participation in any part of Another Bloomin' Bike or any service made available through the bike ride.
Signature_______________________________________ Date:_______ (Signature of Parent if Rider under 18) |
All Pre-Registration Forms Must be
Postmarked by March 8th
Mail to: Metter Kiwanis Club
For More Information:
www.metterkiwanisclub.com