May 29th, 2010
Indian Valley Century Bike Rides
Registration Form

Last Name: First Name:  Age:

Mailing Address:

City:     State:  AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY  Zip:

Home Phone: - Emergency Phone: -

Registration

Metric 100:  $50 per person = .00
              16 and under: $25 = .00 

Mile 100:  $50 per person = .00
           16 and under: $25 = .00 

Late Registration Fee, after May 8th:

Either Ride, add $5 per person = .00

Total Enclosed: .00

 
RELEASE STATEMENT: I hereby release all sponsors and organizers of Indian Valley Century Rides as well as all units of government and private land holders whose jurisdiction this event shall pass through, all agents and officers of the above and all parties associated with this event, for the responsibility for injury to myself and my equipment sustained during the course of this event. I also agree to abide by the rules established for the Indian Valley Century Rides and those established for traffic laws of California.

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Rider's Signature

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Parent / Guardian (of those under 18 yr. old)          Relationship

A parent or guardian must sign the release for riders younger than 18 and must accompany riders younger than 16. Each rider must sign an entry form. 

Click HERE to print this page, and mail the filled-in form with signed release and remittance to: 

I.V.C. of C,
P.O. Box 516, Greenville, CA 95947