Morse Lake Metric/June Bug Jamboree 2011 Mail-in Registration Form

May 15, 2011/June 5, 2011

Registration Form Required For Each Rider

(Walk-ons welcome! On-site registration is available day of ride)

 

Last Name:
First Name:
 
Address:
 
City:
State:
Zip Code:
Phone Number:
Age:
 
E-Mail Address:
 
MLM Distance
15 Miles
35 Miles
62 Miles
JBJ Distance
25 Miles
55 Miles
100 Miles

(Routes may vary up - distances are approximate)

Release of Organizers and Sponsors: In signing this form for myself, or the abovenamed participant, I understand and agree to absolve all sponsors, organizers, associated entities, and Hamilton Heights High School and Shelbyville High School, be they individuals or organizations, singly and collectively, of all blame for any injury, misadventure, harm, loss or inconvenience suffered as a result of taking part in the Annual Morse Lake Metric or June Bug Jamboree or any activity associated with these events.

 

Signature _______________________________________ Date _________________________

(If the participant is under 18, a Parent or Guardian must sign.)

 

Pre-Registration Fee

   
Morse Lake Metric
June Bug Jamboree
Individual Rider (Includes T-Shirt; Riders under 6 free, but no T-Shirt.)
$25.00 for one ride or $40.00 for both rides.
YL • S • M • L • XL • XXL +$2
If no size is indicated, XL will be supplied.
       

Family Rate (Immediate Family Only & includes 2 T-shirts)

Names of additional family riders:
$55.00
YL • S • M • L • XL • XXL +$2
If no size is indicated, XL will be supplied.
YL • S • M • L • XL • XXL +$2
     
       
Additional T-shirt (T-shirts will not be mailed)      
YL • S • M • L • XL • XXL +$2
$10.00
       
TOTALS  
       
GRAND TOTAL ENCLOSED    
       
On-site Registration Fee (T-shirt/lunch not included) $25.00    

 

Make checks payable to : WRS Bike Rallies

All entries must be received by May 8th (MLM) or May 25th (JBJ). A $5.00 cancellation fee will be charged. No refunds will be given after May 8th (MLM) or May 25th (JBJ). One person per form (photocopies are acceptable). Please mail this form with your check or money order to:

WRS Bike Rallies

1303 Brookton Ct.

Indianapolis, IN 46260

 

Or - Register online!