| Please call Chris at HuberBikes, 808.936.3762, or e-mail , to register for the camp and to make your desired travel and accommodation arrangements. Then print, complete, and mail this form to Huberbikes, 75-5742 Kuakini Hwy. Ste. 101 Kailua-Kona, HI 96740. A PDF of this form is here. Method of Payment. You may pay by check, money order or credit card: or pay online. (A deposit of $500.00 when this registration form is received and balance on 2/1/05). |
| Information
to be completed by all camp participants (riders). All information shall remain confidential. |
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| Rider's Name________________________________________ | ||||
| Address______________________________________________________________ | ||||
| City___________________________ | State________ | Zip________ | ||
| Telephone_____________________ | Fax_______________________ | |||
| e-mail_________________________ | Age____ | Sex____ | ||
| Cycling Abilities: | Enthusiast ____ |
Licensed
Racer ____ |
Category ____ |
Triathlete ____ |
| Other pertinent info________________________________________________________ | ||||
| _________________________________________________________________________ | ||||
| If
it is medically necessary for you to take certain medications, please list them and reason for use_______________________________ |
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| _________________________________________________________________________ | ||||
|
Risk Disclaimer and Waiver of Liability (all riders please complete) |
| As used herein, "WCC" includes HuberBikes and Chris Huber. The rider acknowledges and agrees that cycling is a hazardous sport; that participation in the subject Winter Cycling Camp (WCC), and that use of roads and related cycling facilities, shall be at the rider's own risk; that WCC does not warrant nor represent the condition of the roads, terrain and other cycling facilities at the WCC; that the rider accepts and assumes all risk of personal injury or death or loss or damage to property while participating in the WCC, whether in using any of the supplied equipment and other related facilities or in the course of instruction and training by WCC instructors or in participating in non-cycling activities or otherwise. The rider further agrees that WCC, its employees and agents shall not be liable for any loss, property damage, personal injury or death resulting from any cause whatsoever including, without limitation, negligence of WCC or its employees or agents or negligence or carelessness of other riders; and the rider completely releases WCC therefrom. I hereby acknowledge that I have read and understand the terms and conditions of the above Risk Disclaimer and Waiver of Liability in favor of WCC, and agree to its terms. |
| Rider's Signature ____________________________Printed Name______________________ |
| Witness _______________________________________ Date________________________ |