EVENT REGISTRATION FORM REGISTRATION FEES

EVENT REGISTRATION FORM
One registration form per bicycle please!
If your family will be riding on several tandems, please register each bicycle showing its captain and
stoker(s). Captain must be age 18 or older. Single bike riders fill out one registration apiece.
Captain (or single bike rider) information:
Last Name:
First Name:
Contact address:
City:
Home phone: (
Postal
Code:
State/Province:
)
-
Cell phone: (
)
-
email:
Stoker #1 Last Name__________________________ First Name________________ Age (if 17 or under)_____
Stoker #2 Last Name__________________________ First Name________________ Age (if 17 or under)_____
Stoker #3 Last Name__________________________ First Name________________ Age (if 17 or under)_____
Stoker #4 Last Name__________________________ First Name________________ Age (if 17 or under)_____
Enter text as you would like on your bicycle license plate:
please check agreement boxes below:
NWTR may publish our first names and city in the
who’s going list online: nwtr.org/2015/Registration
All participants have read and agree to the
hold-harmless agreement (page 3 of this form)
Emergency Contact Name_____________________________ Emergency Contact Phone______________
REGISTRATION FEES:
Registration
Adults (age 18 and over)
Adults registering after June 1, 2015
Children (age 17 & under)
Northwest Tandem Rally 2015
Quantity
x $75/adult
x $95/person
x $15/child
Total Registration Fees:
July 2 – 6, 2015, Bellingham
[email protected]
Amount
$
$
$
$
Registration Form page 1
REGISTRATION FORM - PAGE 2 - OPTIONS
LODGING OPTIONS:
Camping and Dorm registration here. Hotel and other lodging arrangements may be made separately.
Camping is available starting at noon July 2, through noon July 6 for a fixed price covering all nights whether used or
not. Includes showers, restrooms; no hookups available.
Camping
Quantity
Tent - all 4 nights
Vehicle/RV less than 18’ long - all 4 nights
RV 18’ or longer - all 4 nights
Amount
x $50 per tent
$
x $80 per small vehicle
$
x $100 per RV
$
Total Camping Fees:
$
Dorm rooms are available on WWU campus - double occupancy.
WWU Dorm Room
Quantity
Amount
Dorm room Thursday July 2
x $25 per person
$
Dorm room Friday July 3
x $25 per person
$
Dorm room Saturday July 4
x $25 per person
$
Dorm room Sunday July 5
x $25 per person
$
Total Dorm Fees:
$
MEALS OPTIONS:
Breakfast on July 4 is included in rally registration. Lunches July 4 and July 5 are included in rally registration.
July 3 BBQ tickets are available here for pre-registration or at the door if there are still tickets available.
As of April 24, both the July 2 dinner cruise and the July 4 banquet have sold out.
Meal/Event
Quantity
July 2 evening Bellingham Bay dinner cruise
SORRY - CRUISE SOLD OUT
July 3 welcome BBQ at host hotel, 4:00 - 8:00 pm
x $15 per person
July 4 Banquet
July 4 Beer Tasting Happy Hour
Amount
SORRY - BANQUET SOLD OUT
4:30 - 6:00 pm
$ ------- 0 ------$
$ ------- 0 -------
x $5 per adult (age 21 and over only)
$
x $8 per person
$
Total Meals Fees:
$
July 5 grab-and-go breakfast
MERCHANDISE OPTIONS:
Bike jerseys, vests, shorts, and jackets will be sold directly from Voler. See nwtr.org/2015/merchandise for details.
You may order long-sleeved Tech-Tee shirts and cotton baseball caps here.
Tech Tee
XS
S
M
L XL 2X 3X
Long-sleeved Tech Tee
indicate quantity in each size
Cotton Baseball Cap
Yellow
Green
Quantity
x $10 for XS, S, M, L, XL
$
x $12 for 2X & 3X
$
Quantity
Indicate quantity of each color
Northwest Tandem Rally 2015
July 2 – 6, 2015, Bellingham
Amount
Amount
x $12
$
Total Merchandise Fees:
$
[email protected]
Registration Form page 2
REGISTRATION FORM - PAGE 3 - SUMMARY
TOTAL CHARGES:
Totals
Amount
Total Registration Fees (from page 1)
$
Total Camping Fees (page 2)
Total Dorm Fees (page 2)
Total Meals Fees (page 2)
Total Merchandise Fees (page 2)
TOTAL DUE
$
$
$
$
$
Make checks payable to: NWTR Bellingham 2015
Print and mail all pages of registration form, plus a check for the total amount due to:
NWTR 2015 c/o J. Longstaff
325 Viewcrest Road
Bellingham, WA 98229
Northwest Tandem Rally (NWTR), Mount Baker Bicycle Club (MBBC), City of Bellingham (COB), Whatcom
County-Washington (WCW), Skagit County-Washington (SCW) for Northwest Tandem Rally 2015 (Event)
2015 RELEASE “Hold-Harmless”AGREEMENT
1. In consideration of the acceptance of this entry and by signing this Release for myself (or for the participant if the participant is under 18) I
agree to RELEASE, HOLD HARMLESS, and INDEMNIFY NWTR, MBBC, COB, WCW, SCW and all their sponsors, their respective officers,
agents, members, employees and volunteers and any and all Countries, States, Departments of Transportation, State Patrols, Counties,
Townships and Cities through which this Event may pass, and any other parties connected with this bicycle event including but not limited to
elected and appointed officials and their employees for any injury, loss or damage suffered as a result of participation in this bicycle Event or
any activity associated with it, including injury, loss or damage caused by the NEGLIGENCE of any party.
2. I understand that there are certain risks associated with bicycle riding, including the risk of serious personal injury or death, and I expressly
agree to assume these risks. I understand the routes chosen may be challenging, not necessarily the safest or easiest routes, and that
weather, road or traffic conditions may make this Event more difficult. I warrant that I am in proper physical condition to participate in this Event,
that I am a sufficiently competent cyclist to handle the road conditions, and that my bicycle is in safe operating condition.
3. I understand that wearing a helmet that meets the CPSC, SNELL, ASTM or ANSI bicycle safety standards can minimize head injuries which
may occur in a cycling accident, and that NWTR, MBBC, COB, WCW, and SCW require all riders to wear helmets. I agree to wear a helmet
while participating in this Event and to follow the rules of the road and all applicable laws and safe bicycling practices. It is my sole responsibility
to insure that my helmet meets CPSC, SNELL, ASTM or ANSI standards and to wear my helmet while participating in this Event.
4. If I resell or transfer my Registration, I agree to HOLD HARMLESS AND INDEMNIFY NWTR, MBBC, COB, WCW, and SCW for any injury,
loss or damage suffered as a result of the participation of the individual using my Registration unless that individual also signs this Release
Agreement.
5. I give permission to NWTR, MBBC, COB, WCW, and SCW to use my image in any future materials should it appear in photos taken during this
Event.
6. I understand that this Release is also binding on my heirs and representatives. If I am signing on behalf of a minor, I accept full responsibility for
all medical expenses incurred as a result of the minor’s participation. I agree to HOLD HARMLESS and INDEMNIFY the entities named above
for any claims brought on behalf of the minor.
7. By registering, I agree to read and familiarize myself with the information in the Event registration materials and follow the procedures and
rules.
8. Any legal action that may arise from my participation in this Event will be handled in the state of Washington according to Washington State law.
9. NWTR, MBBC, COB, WCW, and SCW reserve the right to remove any participating rider from this Event if said rider is deemed by an
authorized agent to be endangering him/herself or other participants, or is riding illegally as defined by Washington State traffic law.
Notwithstanding this clause, NWTR, MBBC, COB, WCW, and SCW are not responsible for cyclists not removed from the Event for these or
any other reason(s) and this clause shall in no way supersede, exempt participants from or otherwise nullify any other clause in this release
agreement.
Northwest Tandem Rally 2015
July 2 – 6, 2015, Bellingham
[email protected]
Registration Form page 3