Print It Out, Fill It In, and Mail It! Event Date June 1, 2008 |
|
Make checks payable to The West Georgia 100 Amount Included________ ($25 per person by May 23, $30 after May 21) Additional donations gratefully accepted! ______________ Name_____________________________ Address____________________________ City______________________ State________ Zip______________ Phone_________________________ eMail_________________________ Will you want SHOWER ACCESS? YES_____ NO_____ T Shirt Size Check One: Small__ Medium__ Large__ XL__ XXL__ Distance Option in Miles Check One: 12__ 25__ 50__ 66__ 100__ In consideration of my participation, I agree not to hold the University of West Georgia, Perpetual Motion Bicycles or any other agent or representative of the "West Georgia 100" liable for any injury or damage, however caused, which may result from my participation. I understand that additional waivers will require my signature on the day of the event. Signature________________________________________________ Signature________________________________________________ Parent/Guardian if under 18__________________________________ Registration is on the
campus of The University of West Georgia. |