Wakita Cherokee Strip Land Run Bike Ride

http://www.oklahomabicyclesociety.com/2009EventsCalendar.htm
Text Box: Wakita Cherokee Strip Land Run Bike Rider When: Saturday, September 19th, 45 and 63 miles starting at 7:30 a.m. 3, 11, and 23 mile start 8:30 a.m. Where: Main Street, Wakita Why: Help support Wakita Lion’s Club Old Settler’s Celebration How: Road ride for bikes, terrain mostly flat Costs: $20 Single and $30.00 tandem (includes meal at Methodist Church or Sr. Class Booth) Family fun ride (3 mile) - $5.00 for single and $10.00 for family (no lunch included) Distances: 3 mile fun ride, 11 miles, 23 miles, 45 miles and 63 miles Contact: Gary Feist (work) 620-842-3129, (cell) 620-845-0500, (home) 580-594-2557 Email-skcg.a2@pcca.com Wakita Cherokee Strip Land Run Bike Ride Make checks payable to Wakita Lion’s Club Mail to: Gary Feist RR 1 Box 93 Manchester, Ok 73758 One entry form per rider including tandem-teams. Please print legibly. First Name _______________________________________________ Last Name _______________________________________________ Address _________________________________________________ City __________________________State_____________Zip_____________ Phone ___________________________ email _________________________ Age on 09-13-09 __________________ Male Female $20.00 per adult rider ($30 for tandem teams $5.00 for single and $10.00 for family for Family Fun Ride No rider allowed without signed entry/waiver form. Select event 63 mile 45 mile 23 mile 11 mile 3-mile Family Fun Ride T-Shirt size Small Medium Large X-large To receive a T-shirt, entry must be received by September 9th Release: I, the undersigned, hereby agree to make the following contractual representations and agreements. I fully realize the dangers of participation in the sport of bicycling, bicycle rides, and bicycle related functions, and fully assume the risks associated with the participation in the event known as the Cherokee Strip Land Run Bike Ride including, but no limited to the following: The danger of collisions with pedestrians, other vehicles including cars and trucks, and other riders, the danger associated with equipment failure, inadequate safety equipment, the danger associated with weather conditions, and the possibility of serious physical and/or mental injuries associated with the participation in said bicycle activities. I thereby waive, release and discharge for myself, my heirs, executors, and successors in interest (hereafter, collectively successors) any and all rights and claims which I have, or which may hereafter accrue to me, against the Wakita Lion’s Club or any officer, member or sponsor thereof. I agree for myself and successors that the above representations are contractually binding and are not mere recitals, and that should I or my successors assert any claim in connection with this agreement., I or my successors shall be liable fo rthe expenses including attorney fees incurring by the Wakita Lion’s Club or any officer, member, or sponsor thereof. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or an consent to any other provision herein or as consent to any subsequent waiver modifications. ______________________________________________ __________________ Signature of Applicant Date ______________________________________________ __________________ Signature of Parent/Guardian or Minor Date

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