Please print neatly or type in and print out on your printer.
Fill out a separate form for each person, and sign and date each form.
Name... DOB... Age...
Address... Emergency Contact... Contact's Phone...

City... State... Zip...
Telephone... Email...
Circle Distance

12  20  33  41  52  64

 Is this your first B & B tour?

          Yes           No

T-Shirt Size

S    M    L    XL

Entry Fee
  $25 postmarked before March 14, 2007

  After $30

Make Checks Payable to:
     Tyler Bicycle Club
Mail to:
    Tyler Bicycle Club

    P.O. Box 6734

    Tyler, TX 75711
1.  I acknowledge, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified to participate in such activity.  I further acknowledge that the Activity will be conducted over public roads and other public facilities where the hazards of traveling are to be expected.  I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2.  I hereby make known to whomever it may concern that I hold the Tyler Bicycle Club, its Officers, Members and Ride Leaders blameless in case of accident, injury, or misadventure of any kind.  I recognize my personal responsibility and will do my part to develop and follow safe cycling habits whether riding alone or in a group.

Signature                                                            Date

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