To register by mail fill out this form, print it, sign it then mail with payment to:

Wheel Help Rides
6415 SW 153rd Ave
Beaverton, Oregon 97007

This registration is not valid unless the waiver is signed

Name:          Age:     M     F

Address: 

City:              State:        Zip:

Phone:          Email:  

Course:            35 Mile     65 Mile     100 Mile

T-Shirt Size            S     M     L     XL     XXL

Is your company sponsoring you?    Yes     No  

Company:   

Total (Make check payable to Wheel Help Rides)                            $

Waiver

All participants must read and sign this waiver.  If a participant is under 18 years of age, parent or legal guardian must sign.

I understand that participation in the Vine Ride is a potentially hazardous activity, which poses a risk of injury to my person or property.  I will not participate in the Vine Ride unless I am medically able and properly trained to complete the route I have chosen.  I will examine all risks associated with participation, including but not limited to weather conditions, road conditions, and traffic conditions (motor, bicycle and pedestrian).  I assume the risk of such conditions, and I waive specific notice of such conditions.

I will pay my own medical and emergency expenses in the event of an accident, illness, or other incapacity.  I authorized Wheel Help Rides to secure any medical or emergency services it deems necessary for my benefit.  I will indemnify Wheel Help Rides and hold them harmless from such expenses.

I agree that Wheel Help Rides and sponsors of the Vine Ride may use my name, address, phone, or picture for publicity or promotional purposes without liability or obligation to me.

I will assess and complete any needed maintenance or repairs on my bicycle before participating in the Vine Ride.  I will wear a Snell or ANSI approved helmet while participating in the Vine Ride.  I will obey the rules of the road while participating in the Vine Ride.  I will follow the instructions and directions given by the Vine Ride officials.

I agree to waive and release Wheel Help Rides, its directors, officers, employees and agents, and all beneficiaries, sponsors or volunteers of the Vine Ride, from all claims of liability of any kind arising out of my participation in the Vine Ride, including but not limited to any damage to my person or property caused by any act, or failure to act, by the foregoing persons or entities.

______________________________________________

Signature (parent or guardian if under 18)                  Date