REGISTRATION

Delaware Doublecross

TO REGISTER:

Register online (GetActive)
OR
Print and mail in the form below

Registration Form (Print Out / Fill Out / Mail)

Make check payable to WCBC and mail to:

Jeff Phillips, 126 Leanne Drive, Middletown, DE 19709

Please register me for WCBC's Delaware Doublecross on July 5, 2009

Name: _________________________________________________________________

Address: _______________________________________________________________

City: ____________________________  State: __________  Zip: ____________

Phone (      )____________________


 $______is enclosed for adult registration ($13 if received by mail by June 20; $20 thereafter)
NOTE: Children under the age of 18 are free but must be accompanied by a paid adult).

$______ t-shirt ($10 each, by June 20, circle size:    S     M       L     XL   XXL     XXXL   )  
               
$______ TOTAL     Make check payable to WCBC 

PARTICIPANTS MUST SIGN RELEASE BELOW:
In consideration of the acceptance of my entry: I do hereby, for myself, for my heirs, executors, and administrators waive, release, and forever discharge any and all rights and claims for property damage and/or personal injury which I may have or which may occur to me, against the White Clay Bicycle Club, or any of their officers, members, sponsors, agents or representatives, arising out of traveling to, participating in, or returning from the DELAWARE DOUBLECROSS (07/05/09). Should there be such an incident, I will notify WCBC via the above contact within 48 hours. I agree to wear a HELMET for this event.

Signature of rider: _____________________________________     Date: _________________

Signature of adult supervising minor on ride:  _____________________________________________