the registration form here

SUCKER PUNCH CENTURY RIDE
Saturday, April 25, 2015
Registration: Tear off & mail this form to the address below. Entry form must be received by April 11th to receive discount & be
guaranteed an event t-shirt. On-site registration begins @ 7:00am.
Start Time/Location: Start & finish @ Gear Up Cycles, 102 N. 15th St, Murray KY (Corner of 15th & Main St.)
100 mile ride begins @ 8:00am, 60 mile ride begins @ 8:15am, 30 mile ride begins @ 8:30am
Proceeds: Murray State University Cycling Team
Additional: Food, beverage & toilet facilities will be available on-route @ rest stations.
Sag support provided.
Post-ride meal for all cyclists.
Information concerning route information & directions at www.gearupcycles.com.
(DETACH HERE)
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ENTRY FORM
PLEASE PRINT CLEARLY
NAME:___________________________________________________________ AGE (if under 18)______
EMAIL:___________________________________________________________ GENDER:
M
F
MAILING ADDRESS:__________________________________________________________________
PHONE:______________ EMERGENCY CONTACT(Name & phone#)____________________________________
REGISTRATION: (select one)
____ ($30) Individual Pre-Reg by April 11 (will receive a free event T-shirt.)
____ ($40) Individual Day-of Reg (t-shirts while supplies last)
____ ($5) Individual under 18 (pre-reg by April 11 to receive a free event T-shirt)
ROUTE SELECTION: ____30 Miles
____60 Miles
SIZE(S) & QUANTITY OF SHIRT(S): (adult sizes)
____S ____M ____L ____XL _____XXL
_____100 Miles
Make Check Out to:
Gear Up Cycles
Mail to:
Gear Up Cycles
102 N. 15th St.
Murray, KY 42071
Extra Shirts: _____ X $15 = _________
PARTICIPATION ACKNOWLEDGMENT OF RISK AND RELEASE: In consideration of the services of Gear Up Cycles, LLC and Murray State Cycling Team, their agents, owners, officers,
sponsors, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf of myself, my children, my parents, my heirs, assigns, personal representative and
estate as follows: I acknowledge that bicycling entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties.
I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of these activities. I expressly agree and promise to accept and assume all of the risks existing in this
activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless all
sponsors and organizers, individuals or organizations, from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity, including any such
claims which allege negligent acts or omissions of said individuals or organizations. I further certify I am willing to assume all costs that may be created, directly or indirectly, by any such injury or damage.
I acknowledge that I am responsible for obeying all traffic laws and I am agreeing to wear a bicycle helmet while participating in this event. I have had sufficient opportunity to read this entire document. I
have read and understood it, and I agree to be bound by its terms.
Signature of Participant: ________________________________________________________ Date: ____________________
Signature of Parent/Guardian (if cyclist is under 18) _______________________________________________________________________
ALL PARTICIPANTS MUST WEAR A HELMET & OBEY ALL TRAFFIC LAWS!