Loraine County/Put in Bay Weekend
June 8,9,10, 2012
Application
Print this application and mail to Lake Country Bike to make reservations. Call (814-725-1338) or email lakecountrybike@velocity.net for more information.
Make Checks Payable to: Lake Country Bike, 21 E Main St, North East, PA 16428 814-725-1338 *lakecountrybike@velocity.net* www.lakecountrybike.com
This is a recreational tour, not a race. BICYCLE HELMET IS REQUIRED!
------------------------------------------------------------------------------------------------------------------------------------------------1st Person_________________________________________ email_______________________
2nd Person_________________________________________ email_______________________
Address__________________________________________________________________
City_______________________State________ZIP____________Phone________________
Price: $260 per person _____ $330 per couple _______ Total Enclosed: _______
Release: In consideration of the acceptance of this entry, I waive for myself, my heirs and assigns, all and any claims for damage which I may have against Lake Country Bike (tour directors), sponsors, or any other organizations or individuals as a result of any and all injuries which I may receive during the event. I attest that I am physically fit to participate. I release any photos that may involve me.
1st X______________________________________________________________________________Date_____________
2nd X______________________________________________________________________________Date_____________ Signatures (parent or guardian if under age 18)