2003
Tour of Payne "No Payne, No Gain"
Entry Form
Print and Mail Form * Enclose Entry Fee ($15
on or before June 15 and $20 after June 15, 2003) * Ride Starts At 7:30 AM on
July 4, 2003
Best Western Motel, located at the Northeast corner of McElroy Avenue and Perkins
Road, Stillwater, Payne County, Oklahoma.
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Name:
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_________________________ | Telephone: | (____)___-_______ | |
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Address:
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_________________________ | E-Mail Address: | ____________________ | |
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City, State:
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_________________, _______ | Age on July 4, 2003: |
_____ | |
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Zip:
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___________ | |||
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| Ride Selected: |  28
miles |
38
miles |
62
miles |
100
miles |
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T-Shirt
Size:
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Medium (M) Large
(L) Extra
Large (XL) XXL |
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Waiver
and Release of All Claims
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| This waiver/release claim must be signed before the registration entry will be accepted. I, the undersigned, assume full and complete responsibility for any injury or accident that may occur during my participation in the Red Dirt Pedaler's 2003 Tour of Payne bicycle ride. I hereby release and hold harmless the sponsors, promoters, and all other persons and entities associated with this tour. I understand that a bicycle is a legal vehicle in the State of Oklahoma and that I must ride in a legal and safe manner. I also understand that rest stations close and SAG support ends at 2:30 PM and that I must reach the Cushing Rest Station by 10:30 AM latest to be eligible to continue the century ride. I agree to wear an ANSI or Shell approved helmet. | ||||
| Riders signature: __________________________________________________ Date: _________________ | ||||
| I, as parent/guardian of the above named minor hereby give my permission for my child/ward to participate in the Tour of Payne and further agree, individually and on behalf of my child/ward to the terms above. | ||||
| Parent/Guardian
Signiture (if rider is under 18 years old): ________________________________________ Date: ________________ |
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| In case of emergency, notify: _____________________________________________________________ | ||||
| Phone Number: (______)______-___________ | ||||
Red Dirt Pedalers, P.O. Box 2614, Stillwater, OK 74076