 |
September 18, 2010
|
Ride for Recovery-
September 18, 2010
Departure
Location: |
| Name of Rider | |
| Name of Passenger | |
| Address | |
| City/Zip | |
| Phone | |
| Emergency Contact | |
| Emergency Phone |
| T-Shirt Size (Please Circle One) | M |
L |
XL |
XXL |
XXXL |
| T-Shirt Size (Please Circle One) * | M |
L |
XL |
XXL |
XXXL |
| * For second rider |
Payment
via Cash or Check only please. Check can be made out to: Memorial Hermann Prevention and Recovery Center 3043 Gessner, Houston, TX. 77080 |
| Waiver of Liability: |
| By participating in this event, I realize I am riding on my own free will and that there are inherent dangers associated with motorcycling including injury and death. Dangers can arise from surface hazards, weather conditions, or inadequate safety equipment. I assume all risks associated with such participation. For myself, my heirs, executors, administrators, and successors in interest, I hereby waive, release, discharge, hold harmless, and promise to indemnify and not sue the ride sponsors, its officers, representatives, and/or members or volunteers. I fully understand I am forever giving up, in advance, any right to sue or make any claim against the parties I am releasing if I suffer such injuries and damages, even though I do not know what or how extensive these injuries and damages might be and am voluntarily assuming the risk of injuries and damages. |
| Signature | Date |
| Age of Participant |
| Parent or Legal Guardian (if applicable) |
You can print this page and send it in with your payment or you can download a pdf version of the application by clicking here.