Lancaster Bicycle Club

30^th Annual Covered Bridge Metric Century (Bicycle) Ride

Sunday, August 17, 2008, Greenfield Corporate Center, Lancaster, PA

(Children 12 and under are free, but still need to be registered)

Name:	_____________________________________________________________________ Age: _________
Address	___________________________________________________________________________________
City	______________________________________			State	_____________________		Zip	___________
Telephone		__________________________________		E-Mail Address ___________________________________
I plan to ride:		__ ¼ Metric Century (15 miles) __ ½ Metric Century (31 miles) __ Full Metric Century (62 Miles)
Commemorative T-Shirt or Jersey Order - - -only on or before July 18, 2008 --- Indicate Quantity
T-shirt size (Adults):			___ Small ___ Medium ___ Large ___ X-Large ___ XX-Large
Short Sleeve Jersey			___ Small ___ Medium ___ Large ___ X-Large ___ XX-Large
Registration Fee - $20 fee (increases to $30 after July 18, 2008) (Children 12 and under are free) ----------									$ _________
T-Shirt Order --------------------------------------------------------------------------------						Number ordered __ X $15			$ _________
Jersey Order -------------------------------------------------------------------------------						Number ordered __ X $60			$ _________
Lancaster Bicycle Club Family Membership ----------------------------------------						---------------------------- $12			$ _________
Total Enclosed -----------------------------------------------------------------------------						-------------------------------------			$ _________

I am aware of the risks of bicycling and otherwise participating in this event and voluntarily assume such risks. I release the Lancaster Bicycle Club, P.O.Box 535, Lancaster, PA 17608-0535 and its respective officers, volunteers, and staff from any liability arising out of this event. I do hereby give the Lancaster Bicycle Club, their assigns, licensees, and legal representatives the irrevocable right to use my name (or fictional name), picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for advertising, trade, or any other lawful purposes, and I waive any right to financial consideration and to inspect or approve the finished product, including written copy that my be created in conjunction therewith. I am of full age (*) and I have read this release and am fully familiar with its contents.

Signature of Participant

__________________________________________________

Date

____________________

(*) If the registrant is a minor, I as the minor’s parent or guardian release the Lancaster Bicycle Club from any liability for that minor. I as the parent or guardian of the minor named above and have legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.

Printed Name of Parent/Guardian	______________________________________________________________________
Signature of Parent/Guardian	________________________________________	Date	__________________

Helmets are required! Rain or Shine! Make Checks Payable to: Lancaster Bicycle Club

Mail completed registration & payment to:

Lancaster Bicycle Club – CBMC Registration, P. O. Box 535, Lancaster, PA 17608-0535