to the flier/registration form.

7TH ANNUAL
Sunday, September 11, 2016
Rides depart at 8:30am from Molon Lave Vineyards
Come enjoy a Sunday morning ride in Warrenton, Virginia as we depart from and
return to Molon Lave Vineyards. Following the ride, participants, friends and family
are invited to “chill” at the vineyard.
Three Ride Options:
20 miles • 40 miles • 62 miles
Please visit jccnv.org for more detailed information on ride levels.
Registration fee includes:
Cycle Fest giveaways
Rest stops with tasty treats
SAG vehicle support
Mechanical support
Light food at the end of the ride, wine and olive oil tasting
Molon Lave Vineyards is situated in the middle of 50 acres of land, just south
of Warrenton, Virginia, surrounded by vineyards, forests and ponds. The winery
offers majestic views of the Virginia countryside and a warm Mediterranean décor
with sculpted wood furniture and antique wine making equipment.
Benefiting Wounded Warrior Project whose purpose is to raise awareness and
enlist the public’s aid for the needs of injured service members; to help injured
service members aid and assist each other; and to provide unique, direct programs
and services to meet the needs of injured service members.
Early Registration: $55/ $50 J member
Registration day of event: $65/ $60 J member
Active Military and First Responders: $20
Non-riders: $10
For family pricing, please visit jccnv.org.
To register, complete the registration form (on reverse side), also available at
jccnv.org, and return it to the J, or visit Active.com.
Sponsors
Other proud sponsors:
Earl and Jeff Klioze DDS, Lansdowne Construction, Glenn Fuchs, MD,
Giant Food, Home Style Inn, OSIsoft,LLC
Jewish Community Center of Northern Virginia
8900 Little River Turnpike • Fairfax, VA 22031
www.jccnv.org • Phone: 703.323.0880 • Fax: 703.323.1993
Name _____________________________________________________________________________________ Code: #7639
Address __________________________________City____________________ State _________ Zip Code _______________
Phone (H) (____)_____________________ (W) (_____)____________________ (Cell) (_____)__________________________
Email ___________________________________________________________________________________________________
I plan to ride:
r 20 miles
r 40 miles
r 62 miles
7:30am registration and check in
8:30am rides depart
Rides originate and return to Molon Lave Vineyards, 10075 Lee Mill Road, Warrenton, VA 20186
Early Registration: $55/ $50 J members
Registration day of event: $65/ $60 J members
Active Military and First Responders: $20
Non-Riders: $10
I want to help support fitness and cycle programs at the JCCNV by making a donation (suggested gift: $18).
Feel free to provide an alternative amount below for your 100% tax-deductible gift.
$________General Operations
$________Cycle and Fitness Programs $________Special Needs Programming $________Early Childhood Services
$________Other:_________________
Cycle Fest Total $______________
r Check
r VISA
r MasterCard
Donation Total $_________________ Grand Total $_________________
r American Express
Credit Card # ______________________________________________ Expiration Date _________Security Code _________
Member #____________________________________________Name as Written on Card ____________________________
The JCCNV reserves the right to photograph and or/videotape activities for use in publicity and promotional materials. Please notify the JCCNV in
writing if you do not want photos of either you or your family members to be used and send in a recent photo so that we can be sure that you and/or
your family members are not included in these materials.
Suggested minimum age is 12
Waiver and Release: This entry contains a waiver and limit on your legal rights. I agree to defend, indemnify and
hold harmless the JCC of Northern Virginia and the rider organizing committee and staff, including any and all
participation sponsors and supporters, against all claims, damages and cause of action including court costs and
attorney fees, directly and indirectly arising from any proceedings brought by or prosecuted for my behalf contrary
to this agreement. I attest and verify that I have full knowledge of the risks involved in the ride and that I assume
those risks. I realize expressly that this is strenuous activity and that to the best of my knowledge my training and
health are adequate for me to safely participate in said ride. I will assume and pay my own medical and emergency
expenses in the event of an accident, illness or other incapacity regardless of whether I authorized such expenses.
Further, I hereby acknowledge that I have sole responsibility for my personal possessions and athletic equipment
during this ride. I understand that this is a ride, not a race and it is not a closed course. Riders will be riding in
normal traffic and required to follow all traffic laws and signals. Helmets are required for all registered cyclists, and
head phones are not allowed.
Signature _____________________________________________________ Date: ____________________________
Consent for my minor child to participate _______________________________________________________
The JCCNV is a 501(C)(3) nonprofit service organization with an EIN of #54-1145849. All donations are tax deductible to
the extent permitted by law.
Jewish Community Center of Northern Virginia
8900 Little River Turnpike • Fairfax, VA 22031
www.jccnv.org • Phone: 703.323.0880 • Fax: 703.323.1993