Clark's Corner Ione: Cycling Challenge Registration

Registration: Clark's Corner Cycling Challenge

To register, please complete these two steps:

Your receipt from PayPal will serve as your registration confirmation.
You must complete both steps to be registered for this event.

* indicates required fields

*First Name
*Last Name
*Mailing Address:
Enter Apt, Ste, etc. here:
*City
*State
*Zip

*Email address

*Gender	Male	Female
*Age on event day
Parental Consent (required if entrant is under 18)	I consent to my minor child entering this event
Name of Consenting Parent

*Emergency contact
*Emergency contact phone number

Waiver
By selecting the "I agree" option below, I agree to the terms outlined herein. I understand the registration fee for this event is non-refundable. I am 18 years or older OR I am the parent/guardian of the entrant. I assume all responsibility for injuries and/or damages that may result as an active entrant in this athletic Event. As a condition of my entry, I hereby for myself, my heirs, executors and administrators, release, exempt and discharge Clark's Corner Ione, Event sponsors, Event subcontractors, Event staff, Event volunteers, and cities/towns/municipalities through which the Event passes and properties on which Event festivities will take place from all claims, damages and courses of action, present or future, whether they result from, arise out of or are incident to my participation in the Event. I certify that I am physically fit, will have trained sufficiently for the Event, and will abide by all traffic and Event rules. I also grant permission for the use of my name and/or photographs in press releases, kits, media broadcasts or any other public relations account of the Event.
	*I agree to the above waiver