Champaign County Bikes
One moment please...
TS 101 May 9, 2015
Contact Information
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Cell Phone
*
Email
*
Verify Email
*
League of American Bicyclists Member? Yes/No. If "yes" Membership Number:
What is the approximate longest distance you have ridden in one day during the past year? (_____ miles)
Checkboxes
Check the kinds of riding you do, or have done:
Local recreational
Long distance
Very little
Commuting to work
Fitness riding
None
What are the most important thing(s) you hope to get from this course?
Are there any physical or emotional conditions that might limit your participation in this course?
Checkboxes
*
Release: (Note: Helmets are required for all participants.) I am aware of the risk of bicycling and otherwise participating in this event and voluntarily assume such risk. In consideration of being permitted to participate in this event: (1) I release for myself, my heirs, and personaf'representatives, the League of American Bicyclists, Inc., and the respective directors, officers, volunteers, and staff (releasees) from any claim liability, demand, action, and cause of action whatsoever (collectively, "Claim") arising out of or relaied to any loss, damage or injury (collectively, "Loss"), to myself or my property, that I may sustain in connection with, or arising out of, this event, whether caused by the negligence of the releasees or otherwise; (2) If registrant is a minor, I (as parent or guardian) agree to indemnify and hold harmless each releasee against any claim for any Loss said minor may sustain in connection with or arising out of, this event, and against legal or other expenses incurred by any releasee in connection with defending any Claim by or on behalf of said minor for any such loss, whether caused by the negligence of the releasees or otherwise; (3) I shall obey traffic laws and practice safety in bicycling; and (4) I agree to wear a CPSC-approved helmet on all bicycle-riding activities at this event.
Check here for electronic signature.
Today's date
*
(mm/dd/yyyy)
TS 101 Course Fee: $65 Enter 0 if you are paying by check.
$65
-
Online payment.
$0
-
Will pay by check.