CHATTOOGA CENTURY 2008 Registration Form Saturday August 16th 2008
One entry per form $25 if received by August 14, 2008 $30 if received after deadline and day of ride Mail form and entry fee to: P.O BOX 401 Summerville GA, 30747 Make checks payable to: CHS Athletic Boosters (Circle Event Choices) 15M 30M  62M  100M 125M T-Shirt size adult: M L X-L XX-L ___________________________________________________ M F Last Name M I First Name ____________________________________________________ Street Address ____________________________________________________ City State Zip (____)______________________(____)___________________ Home Phone Work Phone ______________________@_____________________ email Accident Waiver and Release of Liability In consideration of my acceptance for entry in the Chattooga Century for 2008 I hereby waive, release and discharge any and all claims for damages for death, personal injury, or property damage which I may have or which hereafter may accrue to me, as a result of my participation of said event. This release is intended to discharge in advance the promoters, sponsors, and any involved municipalities or other public entities and their respective agents and employees, from and against any and all liabilities arising out of or connected in any way with my participation in said event, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that this event will require me to engage in strenuous physical activity at high altitude and in possible adverse weather conditions. I further understand that serious accidents occasionally occur during bicycle riding; and the participants in bicycle riding occasionally sustain mortal or serious physical injury; and/or property damage, as a consequence thereof. Knowing the risk of bicycle riding, nevertheless, I hereby agree to assume these risks and to release and hold harmless all persons or entities mentioned above who (through negligence or carelessness), might otherwise be liable to me (or my heirs or assigns) for damages. It is further understood and agreed that this waiver, release and assumption of risk, is to be binding on my heirs and assigns. ALL riders must wear helmets! ALL riders being registered must sign this release! NAME_______________________AGE_____SIGNATURE________________________DATE:_______ NAME_______________________AGE_____SIGNATURE________________________DATE:_______                                                                 Signature of parent or guardian is required if applicant is                                                                 under 18 years old                                                                 No one under 13 may ride unless accompanied by an adult.