REGISTRATION
Icicle Metric

 

PRINT AND MAIL IN FORM BELOW

Registration Form (Print Out / Fill Out / Mail)

Please register me for WCBC's Icicle Metric Century (Please Print Clearly)


Name: _________________________________________________________________

Address: _______________________________________________________________

City: ____________________________  State: __________  Zip: ____________

Phone (      )______________________________

Mail To: David Vispi, 19 New Haven Drive, Newark, DE 19713

Amount Enclosed:  $   _______  $15 ($12 if received by mail by March 21!)
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 ICICLE METRIC (3/29/08). 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: __________________________________