Tour of Chautauqua Registration 2007 - Aug. 11, 2007

Name of rider

Address

Age and Date of birth

T - Shirt size (choose one)

Registration Form :

Advance registration, postmarked or submitted on-line (we must receive your remittance by the date listed to be considered registered) on or before July 27 is $13.00 and riders will receive a TOUR OF CHAUTUAQUA T-shirt.

Registrations after July 27, is $15.00 and late registrants will receive a TOUR OF CHAUTAUQUA water bottle.

Call 716.326.4243 for more information.

Sponsored by the Westfield Recreation Department

After submitting this form you must send your remittance to :

Westfield Recreation Dept.

23 Elm Street

Westfield, N.Y.   14787

This form can be printed using your browser's print function

One rider per form

RELEASE:  (required)

In consideration of the acceptance of this entry, I wave for myself, my heirs and assigns, all and any claims for damage which I may have against the TOUR, its directors, sponsors, or any other organizations or individual as a result of any and all injuries I may receive during the event.  I attest that I am physically fit to participate.  I release any photos that may involve myself, and I give permission to provide medical treatment to me in case of injury or illness.

Name of person signing:

(Parent or guardian of under 18 years)

Relationship:

Date:

By clicking here , you attest to the truth and validity of the above information. You will be asked to provide a written signature upon arrival.

Male
Female

S
M
L
XL

Father
Mother
Guardian
Self

I  AGREE