Rider Name:
Age:
......Gender: Male
Female
Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Home Phone:
Work:
Cell:
E-Mail Address* :
....
Occupation:
(*Note: e-mail address will be used for registration confirmation, information, and tour rider contact only!!)
Team/Club:
How many yrs. have you ridden the BTC?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
(Select One)
Complimentary 2011 Tour T-Shirt Size (Select One):
Sm
Med
Large
X-Large
XX-Large
Emergency Contact Info:-------------------------------------------------------------------------------------------------------
Emergency
Contact:
Emergency Contact Phone:
Emergency Contact Relationship:
Emergency Contact Address:
City:
State/Province:
Country:
ZIP/Postal Code:
Rider Health/Medical:
--------------------------------------------------------------------------------------------------------------
Medication Allergies:
No
Yes
If you have Medication Allergies please explain/describe here,
if not type "None" in box below:
Taking Medications/Currently:
No
Yes
If you are taking Medications please explain/describe here, if not type "None" in the box below:
Medical Problems/Condition:
No
Yes
If you have Medical Problems please explain/describe here, if not type "None" in the box below:
Camping/Lodging Choice: --------Please select one of the options below -----------------------------------
Outdoor Camping or I am making my own arrangements (No add'l. charge)
Indoor Camping (Add'l 50.00 Fee)
Tent Service (Contact Shuttleguy at 800-675-2295 for tent reservations,
bag transfer, towel service, etc.)
Hotel/Motel (Contact Premier Deliver Service at 303-238-1501 for reservations, and transfer services.)
Meals: --------To ensure your meal availability in each
town, make your meal selections below !!!--------
----------------------Choose All Meals or one or more combinations of Breakfast, Lunch and/or Dinner.
>----------------------Select Regular or Vegetarian for meal or all meals package.
All Meals (Breakfast 7 Days, Lunch 5 Days, Dinner 5 Days- -Add'l.
$309.00)
None
Regular
Vegetarian
Breakfasts (7 Days, including the day off - - Add'l. $109.00)
None
Regular
Vegetarian
Lunches (5 Days - - Add'l. $90.00)
None
Regular
Vegetarian
Dinners (5 Days - - Add'l. $110.00)
None
Regular
Vegetarian
Other Fees: ---------------------------Select only the
items needed below. -------------------------------------
Bicycle Box Storage at Start/Finish area (Add'l. $25.00)
No
Yes
Week long Parking Permit - Lot in Central City (Add'l. $35.00)
No
Yes
In-Training t-shirt to keep you motivated! (Addl. $25)
None
S
M
L
XL
XXL
2011 BTC Regular Sleeved Jersey (Add'l. $69.00)
None
S
M
L
XL
XXL
2011 BTC Sleeveless Jersey (Add'l. $69.00)
None
S
M
L
XL
XXL
2011 BTC Rider Waiver:
WAIVER and RELEASE
Bicycle Tour of Colorado 2011 Release, Waiver of Liability, Assumption
of Risk and Indemnity and
Parental Consent Agreement
ANSI or SNELL approved helmets are required. Please
read and sign waiver. Riders under 18 must be accompanied by an adult
at least 21 years of age.
In consideration of the acceptance of my entry, I, the undersigned participant, for myself, my family members, heirs, administrators, personal representatives, successors and assigns hereby fully release, discharge and hold harmless Bicycle Tour of Colorado, Inc. (BTC), any sponsors, owners and operations of motor vehicles and officers, directors, employees, volunteers and lessors of any of the foregoing persons, or entities from all liability, whether resulting from negligence of any aspect of the BTC and hereby acknowledge that the above persons and entities have no obligation to provide medical care and have not undertaken the responsibility to do so. In the event that I receive medical care as a result of a medical emergency, I hereby consent to such care and fully release the person(s) providing such care from any and all liability, whether resulting from negligence or otherwise. I authorize and consent to persons employed or contracted by BTC, whether by videotape, film, newsprint, written advertisement or otherwise, of any materials containing my name or picture and I release any sponsors and persons acting under authority from any claims I might have due to initial or subsequent publication of any such materials or photographs. I acknowledge that if my photo or name is used in such materials I will not be receiving any compensation whatsoever. In the event the ride does not take place due to some unforeseen event, act of god, or any reason beyond the BTC's reasonable control the money paid to the BTC will not be refunded. I agree that the BTC is not responsible for lost or stolen items. I hereby certify that I have fully read and understand foregoing release, waiver and covenant not to sue, and sign it voluntarily. I also agree to wear a helmet at all times during the ride. I represent that I have medical insurance. I understand that when five sign up and the sixth is free, there will be no refunds of the registration fee when the first cancellation is processed from the group of six.
I understand that personal sags are not allowed to park at the overnight campsite in the staff parking area. I have read and understand the cancellation policy. I understand my registration is non-transferable. I understand that my registration fees, as well as any other fees are non-refundable after April 30, 2011 for any reason, work and/or medical included. I have read and understand the waiver and the cancellation policy and sign voluntarily.
Signature __________________________________ Date _____________
Signature of Guardian, if rider is under 18. Guardian must be
registered for the 2011 tour.
I agree to and will abide by BTC Waiver and Terms of Participation
stated above.
REGISTRATIONS ARE NOT TRANSFERABLE AND THERE ARE NO CARRY-OVERS NO TRANFERS ARE ALLOWED FOR ANY REASON
2011 BTC Cancellation Policy:
Refund requests must be made in writing and mailed by Postal Mail
to the Bicycle Tour of Colorado postmarked by April 30, 2011. Mail to: BTC PO Box 719, Morrison, CO 80465
Refunds submitted and acknowledged prior to April 30, 2011 will be
refunded in full, minus a $75.00 processing fee.
No transfers or carry-overs will be given. No refunds will be given
after April 30, 2011 for any reason, medical, work related, or otherwise.
For information on trip cancellation insurance, visit www.mckayinsagency.com .
I understand and agree to abide by BTC Cancellation Policy stated above.