Scenic Bike Tour 2000 Registration

Please fill in all fields below before submitting this form. There is a non-refundable $25 registration fee for the Scenic Bike Tour ($30 after May 18th). Note: if you are uncomfortable providing your credit card information on the web, please print and fax this form to 617-969-4480.

How did you hear about us? Name Address ,City/State/Zip Day Phone Evening Phone Your E-Mail Age Male Female T-Shirt Size M L XL Route 20 40 60 (note preference may be changed on the day of the ride) Credit Card M/C VISA Other Credit Card Number Expiration Date Charge Credit Card For Registration Fee $25 ($30 after May 18th) I would like to submit the minimum personal pledges now of $100 I would like to submit the additional personal pledges now of $ I cannot ride but please accept my donation of $ For the record! Please send me more pledge sheets Please send me brochures to hand out to my friends I cannot ride but would like to volunteer WAIVER In signing this release, I understand the intent thereof, and I, for myself, my heirs, executors and administrators, hereby agree and absolve and hold harmless the St. Jude Children s Research Hospital, the sponsors, and any other parties connected with this event in any way, singularly or collectively, from and against any blame and liability of participation in the Scenic Bike Tour or any activities associated here-with. I also hereby consent to and permit emergency treatment in the event of injury or illness during the event. I also understand photos taken by the tour staff photographer are the property of the Scenic Bike Tour and maybe used in future promotions. I also agree to wear a protective helmet. I understand and agree to the above waiver. Any Additional Notes or Questions

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