1st Annual Cycle Jam Registration Form

Registration before April 1: $35, $40 after.

Name *
Email *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Length *
T-Shirt Size *
Payment Method *
Phone * - (###) - ### ####
Emergency Contact * - (###) - ### ####
Please check the box below if you agree. * I hereby make known to whomever it may concern that I, my heirs, executor, and administrators waive, release and forever discharge all rights and claims which I may have or whichever accrued to me against the promoters and sponsors and or any other person or entity connected with the Cycle Jam event, individually or collectively from all responsibility of any injury or property damage during the event or while being transported to or from the event. If under 18, have parent sign for permission. Riders under 18 must be accompanied by a parent or legal guardian during the entire ride. Sign below stating you agree to the rules and regulations of the Cycle Jam.