Name: _______________________________________________

Address: ______________________________________________

_____________________________________________________

City: _________________________________________________

State: _________________         Zip: ________________________

Phone: H ______/____________________       W _______/____________________

E-mail: _____________________________________________________________

Age: _______         Sex:  M ___   F ___          T-Shirt Size:  S___   M ___   L ___   XL ___   2XL ___

Referral: Bike Shop ___   Expo ___   Magazine Advertising ___   Bicycle Club ___
                 Internet ___   Friend ___   Other ________________________________

Check Tour(s) Entering     

Transportation (use additional sheet if needed)

Motel Service

___ Check here for Motel Service (available for Pedal the Peaks and all National Park Tours)  - $35 service fee per tour.  There is no Motel Service for the Cross-State Tours/Coast-to-Coast. Details in Tour Kit.

Vegetarian Preference

___ Check here to choose vegetarian meals (including some egg and milk dairy products).

Payment

Mail this entry form and waiver with US $200 deposit per tour entered (US $1050 for Coast-to-Coast). This deposit reserves space based on availability. If using Transportation or optional Motel Service (see above), also include these fees. Your final balance is due six weeks prior to tour start. Entries sent in fewer than six weeks before tour start must include full payment for tour, transportation, and any additional services.

Card Number (Write all digits): ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Expiration Date: ___ ___ /___ ___

Signature of Card Holder: _____________________________________________________

Please read, sign below and return with Entry Form. You cannot ride without a signed Waiver, Release, and Consent.

I hereby release and discharge Cycle America, GW Promotions LLC, and any associated organization (including but not limited to school districts, municipalities, churches, clubs, campgrounds, sponsors, volunteers, and any employee or associates thereof) their heirs, administrators, agents and employees, from any and all liability, causes of action, suits, debts, contracts, agreements, claims and demands whatsoever as a result of my participation in a Cycle America event.

I understand that accidents, fatalities, serious bodily injuries and/or property damage can occur while participating in a Cycle America event, while riding a bicycle on public roads or otherwise participating in said event. Knowing the risks involved, I agree to assume those risks and to release all of the persons or entities mentioned above from liability for any injury, death, illness or property damage occurring while participating in these events or in the travel to and from them.

I agree that I will use good judgment, be self-reliant and stop to request assistance if I am unsure of my ability to complete any segment of the event safely. In extreme situations I understand and agree not to wait for assistance exclusive to the support provided by Cycle America. In the event of any injury or accident, I agree to notify the event leader, and consent to and permit emergency medical treatment. In this regard, I understand that I must provide a completed medical registration form prior to being accepted as a participant in the event.

I understand that if I leave before the posted daily starting time or travel a course different from the official route, I will not receive the services as published or advertised. I further agree to pay all fees associated with my participation in all or part of the event.

I attest that I am physically fit and have sufficiently prepared for the completion of the Cycle America event(s) entered. I also agree to wear an ANSI, CPSC or SNELL approved bicycle helmet at all times when riding a bicycle during this event. I agree to have adequate medical insurance coverage for the duration of the entered Cycle America event(s).

I attest that I will abide by the rules and regulations of these events and all applicable state, local and municipal laws, including vehicle laws. I understand Cycle America and GW Promotions LLC reserve the right to remove participants unwilling to ride in a safe manner or displaying unacceptable behavior and to change or cancel events. (Full refunds will be given for events canceled by Cycle America.) I further understand that I will not be reimbursed for airline fees due to change in itinerary or event cancellation or compensated for the theft of any personal gear, including bicycle.

I give permission to Cycle America and GW Promotions LLC to use my name, photographs, motion pictures, recordings, evaluations or any other record of my participation in Cycle America event(s) for any promotional purposes, without obligation or liability to me.

Signature: __________________________________________

Name (print): ________________________________________

Date: ______/______/______

If you are under 18 years old, the following must be signed by your parent or guardian:

I, being the parent or legal guardian of the above entrant, who is under the age of eighteen (18) years, having read and understood this complete waiver, do hereby consent that the above mentioned entrant may participate in the Cycle America tour. I do hereby adopt entirely the above-recited "Waiver, Release and Consent."

Signature: ___________________________________________

Name (print): _________________________________________

Date: ______/______/______