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(Please print all information) This information will be shared with Eagle Mountain Casino so they may prepare your personalized $25.00 Player Card. If you would prefer for us not to share this information please initial here. _____
Rider Name_______________________________ Passenger Name________________________________
Address___________________________________ City____________________ St____ Zip___________
Best Contact Phone #___________Drivers Lic #____________ E-mail address________________________
[ ] New Rider [ ] Previous Rider (If you are a previous rider, is this a change of address? [ ] Yes [ ] No
T-SHIRTS WILL BE PROVIDED TO THE FIRST 650 PARTICIPANTS (remember its all about the kids).
Rider: $35.00 ($30.00 before Oct. 30th) $_______________ (includes t-shirt, ride pin, $25.00 EM* Token, meal & drink)
Passenger: $30.00 ($25.00 before Oct. 30th) $____________ (includes t-shirt, ride pin, $25.00 EM* Token, meal & drink)
Additional Meal Tickets X $15.00 (ea.) $______________ *Eagle Mountain Casino "Free-Slot Play"
TOTAL: $_______________ Check T-Shirt Size: [ ] MEDIUM [ ] LARGE [ ] X-LARGE [ ] XX-LARGE (mark one size for each paid rider/passenger) ALL CHECKS PAYABLE TO: G For Kids 501(c)(3) 94-3460050
Mail check and registration to: G For Kids / P. O. Box 1431 / Visalia, CA 93279
Contact person: Mary Dennis at 559-303-3030 / bikersunited@gforkids.com
G FOR KIDS, INC IS A 501 (C) (3) ID# 94-3460050
TERMS OF PARTICIPATION – WAIVER & RELEASE
In consideration for being permitted to participate in the Bikers United Motorcycle Run 2011, on behalf of myself, executors and assigns, I hereby assume all risk in connection with my participation in such event, including but not limited to the risk of personal injury, property damage or harm of any type or nature whatsoever to my person or property whether foreseeable or unforeseeable. I understand and agree that nobody will be allowed to make any claim for damage or injury against G For Kids, its predecessors and assigns, other ride sponsors and vendors or any of the public entities through which the ride may travel (the “released parties”). I hereby release the released parties from all actions or claims that I, my assignees, heirs, distributees and legal representatives may have for death, damage or harm of any nature that I may sustain.
I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS SET FORTH ABOVE
Rider: Signature Date
Passenger: Signature Date
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