Saturday, Oct. 20, 2007 Register at 8:00AM Ride at 9:00AM
Participant
Entry
Form:
See Sept/Oct issues of FreeWheelin’. A Donation: $25 if postmarked by Oct. 8th. $30 after or on day of ride. Add $10 to order T-Shirt. Make checks payable to the Kiwanis Club and mail to: P.O. Box 2506 Cumming, Ga. 30028-2506. Contact: Frank Felker 678-965-6141 ex 2500; email: ffelker@habcorp.com or visit our web site: www.cummingkiwanis.org for more ride camping or hotel information.
On Line Registration: http://www.active.com/event_detail.cfm?event_id=1478158
First
Name__________________________ Last Name_________________________________
Address___________________________________________________
City______________________________ State____________ Zip Code___________
Phone___________________ E-mail_______________________________________________
Age: ____ Male___ Female___ “T” Shirt Size, circle one:
Small Medium Large XL XXL (Add $10 for T-shirt order)
Emergency Contact: Name ___________________________________ Phone No. ____________________
Distance: _____ 25 Miles ______ 42 Miles _____ 69 Miles _____ 100 Miles for experienced cyclists only!
Waiver / Release Form: In consideration of this entry, I waive any and all claims for myself and my heirs, Kiwanis Club, Forsyth, Dawson, Lumpkin & Pickens Counties and their respective officials for illness, injury or death directly or indirectly for my participation in Sawnee Mountain Century Challenge. I understand that bicycling can be a hazard that could result
in injury or even death. I am in proper
physical condition to participate in this event.
Signature________________________________________Date____________
Signature________________________________________Date____________ Relationship_______
If under 18 must be signed by parent or guardian
Corporate Sponsors We sincerely thank the following 2007 sponsors:
