Big Bike Run Registration Form

Be Safe! Ride At Your Own Risk!

Package Options

Packages

Package A: ($50) Includes wristband for one rider, one t-shirt, two 50/50 tickets and 1 coupon for an extra card a $60 Value!

Package B: ($100) Includes wristbands for two riders, two t-shirts, four 50/50 tickets and 2 coupons (1 per rider) for an extra card a $115 Value!

A La Carte Items

Type in your quantity below.

	Rider(s) (wrist band(s) $25
	Additional passenger(s) $20
	SIZE MEDIUM t-shirts (s) $10
	SIZE LARGE t-shirts (s) $10
	SIZE XL t-shirts (s) $10
	SIZE XXL t-shirts (s) $10
	SIZE XXXL t-shirts (s) $10
	50/50 ticket(s) $10

Current Total:

$0.00

Registration Information

Rider Name *

Rider Email Address (Your email address will not be distributed or sold) *

Rider Shirt Size *

Rider 2 Name *

Rider 2 Email Address (Your email address will not be distributed or sold) *

Rider 2 Shirt Size *

Additional passenger(s) name

Where did you hear about us? *

You must read and agree to the following waiver:

WAIVER: In consideration of the entry being accepted, and of being allowed to participate in the Bike Run, I hereby, and for my minor child, heirs, executors and administrators, waive, release and forever discharge, and save harmless from any and all claims for damages and causes of action which may occur, including consequential damages, I may have against Grapevine Heritage AMBUCS, successors, beneficiaries and all other organizers and sponsors and assigns for any and all injuries and damages suffered by me or my rider at this event, whether caused by negligence of Grapevine Heritage AMBUCS or otherwise. I also give my permission for the free use of my name and/or photographs in any broadcast, telecast or other account of this event. Clicking "Agree" below indicates my agreement to assume all risks and abide by the rules and decisions of the event organizers. All minors must obtain parent's consent and signature to participate in activities conducted during this ride.

By clicking "Agree" below, I certify that I understand this agreement and the rules of participation in this event and that I am not relying on any statements or representations made by the event organizers. *

Agree

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