CycleCanada Event
Registration Form. Or, please use the:
PDF Version
Fax to: 705-434-1101, or in North America only - toll free 888-814-2982
or Mail to: P.O. Box 310, Alliston, ON Canada, L9R 1V6
Our telephone number is 705-434-1100 or toll free - 800-214-7798
Event
Pages, Fees and Dates:
All Events
Home:
www.CycleCanada.com |
E-mail: sweep@CycleCanada.com
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| NAME: | PLEASE REGISTER ME FOR
(EVENT CODE (s)): |
|
| ADDRESS: |
Cheque/money order payable to CYCLECANADA: Amount in Cdn$ _______ US$ _______Euros________ |
|
| CITY: | Or, please charge total event fees
to my VISA or MASTERCARD account $: (Use Canadian amounts only for Credit Card Payments) |
|
| PROVINCE/STATE/CODE: | VISA or MASTERCARD NUMBER: | |
| PHONE: (H) | M | F | VISA or MASTERCARD EXPIRY DATE: |
| PHONE: (W) | AGE | CARDHOLDER NAME: |
| E-MAIL: | SIGNATURE & DATE SIGNED: | |
Request a double room with:
|
Please list any allergies or medical conditions we should know about. Ind indicate if you are a vegetarian |
|
Deposits for Cycle Canada events and for Tour du Canada are not refundable. Deposits are not transferrable to another rider. Anyone registering for an event should consult the Cycle Canada statements of practices and policies. Participants may wish to investigate trip cancellation insurance. Organizers reserve the right to cancel a trip for any reason at any time prior to departure and in such case all event deposits paid will be refunded. If an event is cancelled, the organizers are not responsible for additional expenses, such as travel costs.
In consideration of the acceptance of my application
and permission to participate as an entrant in this event I, for myself, my
heirs, executors, administrators, successors and assigns hereby release, waive
and forever discharge Cycle Canada, The Veloforce Corporation and/or VTSJ Groupe
Cycliste pour Tour du Canada, and all supporting bodies, associations, advertisers
and sponsors and all of their respective agents, officers, directors, employees,
volunteers, servants, contractors, representatives, successors and assigns of
and from all claims, demands, damages, costs, expenses, actions and causes of
actions, whether in law or equity, in respect of my participation and notwithstanding
that same may have been contributed to or occasioned by the negligence of any
of the aforesaid. I further undertake to hold and save harmless and agree to
indemnify all the aforesaid for and against any and all liability incurred by
any or all of them arising as a result of or in any way connected to my participation
in the said event. I warrant that I am physically fit to participate in this
event, and that all my equipment is mechanically fit and suitable for its intended
use in the aforementioned event. I certify that I shall heed all traffic laws
and wear a helmet approved by a standards agency accredited by, or recognized
by, the Standards Council of Canada while riding as a participant in this event.
I warrant that I shall wear clothing that is clearly visible from the rear because
of its colour or reflective properties, in addition to any requirements in law
for reflective materials and equipment respecting the safe operation of a bicycle
as a vehicle. I acknowledge having understood that there are inherent risks
involved in the participation in said event, including the potential for permanent
paralysis and death and that I voluntarily take such risks upon myself.
I ACKNOWLEDGE HAVING READ THIS
WAIVER AGREEMENT, FULLY UNDERSTOOD ITS TERMS AND SIGN FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT
SIGNATURE_________________________________________________DATE___________________
FOR PARTICIPANTS OF MINORITY AGE (under age 18
at time of registration): This is to certify
that I, as parent/guardian with legal responsibility for this participant, do
consent and agree to his/her release as provided above of all the releasees,
and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify
the releasees from any and all liabilities to my minor child's involvement or
participation in these programs as provided above.
PARENT GUARADIAN SIGNATURE______________________________________PRINT
NAME & DATE BELOW