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ENTRY FEE
$30 per
Rider This fee covers T-shirt, aid stations, map, and food & refreshments after the ride.
Make checks payable to “W.C. Handy Festival” and mail to W.C. Handy Century Ride at P.O. Box 1827, Florence, Alabama 35631 or pay at registration booth on the day of the ride. Registration forms may also be hand delivered to the Kennedy Douglass Center at 217 E. Tuscaloosa, Florence, Alabama.
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APPLICATION & WAIVER FORM Handy Ride T-shirt guaranteed to those pre-registered/postmarked by July 25th. First come first serve on day of ride. Circle shirt size: S M L XL Name:_____________________________________ Address:___________________________________ City/ST:____________________________________ Zip:_______________________________________ Phone:____________________________________ In consideration for being accepted to participate in the ride, I, the undersigned agree to be legally bound hereby for myself, heirs, executors, and administrators, and do waive and release all rights and claims for damages that I may have against the ride sponsors or organizers, their officials, representatives, successors, and assigns, for any and all injuries suffered by me in this event. I understand the dangers inherent in riding a bicycle on public roadways and verify that I am physically fit and have sufficiently trained for this event. Further, I hereby do grant the Music Preservation Society, Inc., permission to use any photographs, videotapes, motion pictures, recording or any other record of this event for any legitimate purpose. Applicant Signature:__________________________ Date:______________________________________ Parent/Guardian (if rider is under 19) ___________________________________________
Contact in Case of EmergencyName:____________________________________ Phone:____________________________________ Relationship:________________________________ |