Appalachian Bike
Tour Scholarship Ride
23rd Annual 2016 Appalachian Bike Tour Scholarship
The 2016 Appalachian Bike Tour Scholarship Ride will be
September 24, 2016
Yatesville Lake Marina Shelterhouse
Louisa, Kentucky
Bike Tour will be held on
September 24, 2016
Rain or Shine
Registration Time at 8:00AM
Ride Starting Time at 9:00AM
Name:_______________________________________________________________
Address:_____________________________________________________________
City:_____________________ State:__________ Zip Code:_______
Telephone Number: ( ) -
Emergency Contact:_______________________
Age: (If under age 18.) ___________
T-Shirts will be sold at the marina.
Return to:
Donna Childers
3143 Lt. Fork Lil Blaine Rd
Louisa, Kentucky 41230
(606)-673-3084
WAIVER
Helmets are REQUIRED. I understand that the Appalachian Bike Tour requires
bicycle helmets to be worn by all participates while operating bicycles and that there is
no exception to this requirement. I agree to wear a bicycle helmet at all times during
this event when I am operating a bicycle. I am aware of the risks of bicycling and
otherwise participating in this event and voluntarily assume such risks. In
consideration of being permitted to participate in this event: (1.) I release for myself,
my heirs and personal representatives and the undersigned registrant under the age
of 18 (minor)___________________________, Lawrence County Democratic
Woman's Club and their respective directors, officers, volunteers and staff
("indemnities") from any claim, liability, demand, action, and cause of action
whatsoever (collectively claim) arising out of or related to any loss, damage, or injury
(collectively "loss"), to myself or my property, that I may sustain in connection with or
arising out of this event; (2.) If registered as a minor, I (as a parent or guardian) agree
to indemnify and hold harmless each indemnitee against any claim for any loss said
minor may sustain in connection with defending any claim by or on behalf of said
minor for any loss. (3.) Consent to emergency medical treatment if I am injured (4.)
Shall obey the traffic laws and practice safety in bicycling and (5.) Agree to wear an
CPSC or Snell approved helmet on all bicycling riding on this event. If no signature or
guardian appears below, registrant is deemed to confirm being at least of the age
eighteen. And I do hereby, grant permission of any photos taken during the tour to be
used in the redesign of any future web page for the Appalachian Bike Tour.
SIGNATURE:__________________________________Parent or Guardian's
Signature, if rider is less than 18 years old:
_______________________________________________You may make copies of
registration forms if needed
Sponsors:
Lawrence County Democratic Woman's Club
All Proceeds go to the Appalachian Bike Tour Scholarship
Fund: All Fees and Donations are Tax Deductible
Endorsed by the Ashland Cycling Enthusiasts