BCP 2006 Peter Odell Memorial Ride - New Hope to New York - Registration Form

Make checks payable to BCP.

Print and mail this form to: Ted Northrop 7709 Brocklehurst St. Philadelphia, PA 19152

Space is still available!! MUST contact Ted ASAP!, 215-333-7146

Event limited to 106 people. BCP reserves the right to cancel this event if insufficient sign-ups are received.

Miles (circle one) 125 90 70 50

Cost $55 for BCP members $65 for nonmembers

Buses leave the Art Museum at 6:00 AM with your baggage for those taking the bus to New Hope and other starts, and leaves New Hope at 7:30 AM for the 70 and 50 mile starts. Buses leave New York at 9:00 PM SHARP.

NOTE!! If you want to start your ride at New Hope, contact Ted ASAP!, 215-333-7146; you'll need to arrange to get there.

Please use a separate form for each rider (copies are fine), and please write legibly.

Name: __________________________________________________ Phone ( )

Address:

City: ____________________________________________State: ZIP:

E-mail:

Bicycle Club of Philadelphia Release

In signing this release for myself or for the named applicant, if applicant is under the age of 18, I understand that participation in Bicycle Club of Philadelphia (“BCP”) activities is at my own risk. I acknowledge the risks and dangers inherent with such activities and knowingly and voluntarily assume the risk of injury resulting there from. I understand that supervision, training or oversight may not be provided by BCP with respect to all sponsored events and activities. Participation in BCP activities constitutes my representation that (1)

I am in good health, (2) I agree to obey all traffic laws and regulations and practice safety and courtesy in cycling, (3) I agree to wear an approved safety helmet on all BCP sponsored rides, (4) my bicycle is in good and safe mechanical condition, and (5) I acknowledge that BCP and its directors, officers, members, contributors, sponsors, ride leaders and other event coordinators are not insurers of my personal safety or property and do not assume any liability for personal injury or property loss sustained during any BCP sponsored events or activities. By signing below and in consideration for being allowed to participate in any BCP sponsored event or activity, I fully release BCP and its directors, officers, members, contributors, sponsors, ride leaders and other event coordinators from any liability, specifically but not limited to liability for their negligent acts, stemming from or relating to past or future BCP sponsored events or activities.

I HAVE READ AND UNDERSTOOD THIS NOTICE AND RELEASE, AND INTEND TO BE LEGALLY BOUND BY IT.

Signature: Date

(Must be SIGNED by each rider, and by parent if rider is under 18)

Emergency contact: Name Phone ( )

Address _______________________________________________________________________________

If you'll have a cell phone on the ride, number please: ( ) (In case we need to reach you en route)