Back To Ride & Cure Registration
Ride and Cure Registration
You Can Mail or Fax Your Registration To:
PHONE: 425-488-2344 Ext 14 –
docsfoundation@attbi.com
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Money For A Cure For Diabetes? Click Here!
Date: July 20, 2003 ///Location:
Holiday Inn, 101 128th St SE, Everett to Remlinger
Farms, Carnation
Name/Driver: ____________________________ Name/Passenger: _______________________________
Home Address: __________________________ City: ________________ State: _____
Zip:____________
Phone: ________________ Fax: ___________________ Email
Address:___________________________
Driver’s License Number: __________________________
My Total Donation: (from below) $_____________ In Memory Of:
________________________________
Please choose one of
the following payment options:
o Personal Check—Payable to DOCS
Foundation - - - - Credit Card: o Visa o Mastercard
__________________________________________________________________________________________________________
Account Number ............................................................
..... Signature
.......................................................................Exp.Date
A minimum registration fee of $50 is required PER
PERSON for participation in the Ride and Cure Benefit for Diabetes. All
rider registration levels cover your participation in the charity ride, post
ride barbeque and party, ride pin and t shirt while supplies last. Rider and
passenger may register at different levels if they choose—for example, a
rider can register at the $100 level and the passenger at $50. All brands of
bikes are welcome. IMPORTANT IRS NOTE:
Only the portion of your donation that exceeds the value of the goods and
services received are tax deductible under IRS guidelines.
Ride Registration Levels:
$50 Level _____ people x $50 = $___________
Basic Ride Entry,
BBQ lunch & post ride party, Commemorative 2002 Ride Pin & T shirt
(Ride pins are available for the first 200 pre-registered riders)
$100 Level _____ people x $100 = $___________
DOCS
Fanny pack, plus all of the above
$150 Level _____ people
x $150 = $___________
DOCS 2002
Ride Hat, Plus all above
$200 Level _____ people
x $200 = $___________
DOCS 2002
Ride Bandana, Plus all above
$500 Level _____ people
x $500 = $___________
Embroidered DOCS 2002 Travel Bag, Plus all above
$1000 Level _____ people
x $1000 = $___________
Embroidered Suede DOCS 2002 Jacket, On Stage Recognition, Plus all above
RIDE PRIZES WHILE SUPPLIES LAST Additional Pledges Total:
$___________
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Ride and Cure Benefit for Diabetes
Release and Waiver of Liability and Indemnity Agreement
(Must be signed and brought to event, or sent by mail or fax for pre-registration)
IN CONSIDERATION of being allowed participation in the RIDE and CURE, the
undersigned, for himself/herself, his/her personal representatives, heirs,
successors, and assigns, hereby:
RELEASES WAIVES, DISCHARGES AND
COVENANTS NOT TO SUE THE (DOCS FOUNDATION) of the United States of America, the JDRF,
Inc. & related companies and it’s sponsors, the officers , directors,
management, officials, and volunteers assisting in the event, the sanctioning
organization or any subdivision thereof, grounds operators, grounds owners,
officials, promoters, sponsors, advertisers; owners and lessees of premises
used to conduct the event and each of them, their officers and employees, all
for the purpose herein referred to as "releasees,"
from all liability to the undersigned, his personal representatives, assigns,
heirs, and next of kin for any and all loss or damage, and any claim or demands
therefore on account of injury to the person or property or resulting in death
of the undersigned, whether caused by the negligence of the releases of
otherwise while the undersigned is participating in the event AGREES TO
INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any
loss, liability, damage, or cost (including attorney’s fees) that may
occur due to the presence of the undersigned participating in the event and
whether caused by the negligence of the releasees or
otherwise.
THE UNDERSIGNED RIDER agrees that in order to participate in the event, the undersigned rider/driver/passenger must provide a
present valid operator’s license along with proof of personal injury and
property damage liability insurance coverage.
THE UNDERSIGNED FURTHER agrees that while participating in
the event, he or she will not ride while under the influence of alcohol or any
other substance which affects the ability to operate or control his or her
vehicle.
THE UNDERSIGNED AGREES that he or she will not use or operate any
vehicle in violation or contravention of any City, County, State or Federal
Laws, Statutes, Ordinances, penalties and Law Violations.
THE UNDERSIGNED RIDER agrees to wear minimum safety apparel as
required by Law. Minimum safety apparel for these purposes may include a DOT
approved helmet. Rider is strongly advised to wear a helmet whether required to
do so by Law or not, and is strongly advised to wear glasses, goggles, or a
face shield, and additional protective outerwear such as gloves, long sleeved
jackets, boots, and long trousers, such as leather or heavy fabrics while
participating in the event. Rider understands and acknowledges that failure to wear
proper safety apparel may result in the rider’s injury or death. RISK
OF BODILY INJURY, DEATH, PROPERTY DAMAGE due to the negligence of
releases or otherwise while participating in the event. EACH OF THE
UNDERSIGNED expressly acknowledges and agrees that the activities of the
event are dangerous and involve the risk of serious injury and/or property
damage.
THE UNDERSIGNED further expressly agrees that the foregoing
release, waiver, and indemnity agreement is intended to be as broad and
inclusive as is permitted by the State in which it is operated in and that if
any portion thereof is held invalid, it is agreed that the balance shall, not
withstanding, continue in full legal force and effect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNED THE RELEASE AND WAIVER OF
LIABILITY AND INDEMNITY AGREEMENT and further agrees that no
oral representatives, statements or inducements apart from the foregoing
written agreement have been made.
THE UNDERSIGNED ALSO AGREES TO release the use of any photos, slides,
videotapes, etc., that might contain the UNDERSIGNED for future use in
promotional and/or informational activities as deemed appropriate by any of the
releasees.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNED THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND FURTHER AGREES THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING AGREEMENT HAVE BEEN MADE BY THE RELEASEES.
Signature of Rider: _______________________________________ Date: ____________________________
Signature of Passenger: ___________________________________ Date: ____________________________