Wyatt’s Ride 2011

 Registration

Waiver

Wyatt’s Jamboree Bike Run 2011, herein after referred to is operating with the sole purpose of promoting good, clean, and safe activities.  Each member participates in activities solely by choice and participation itself relinquishes any responsibility of Wyatt’s Jamboree Bike Run 2011 for any and all liabilities resulting in participation in this event.  All activities and events must comply with any and all state or local laws and ordinances.  Any personal injury or property damage resulting during this activity or at any time becomes the responsibility of the individual parties involved, and at no time shall Wyatt’s Jamboree Bike Run 2011 be held liable

 

 

________________________    ________________________
Driver Name (Print)                         Signature

 

________________________    ________________________
Passenger Name (Print)                             Signature

 

________________________    ________________________

Street Address City,                         State Zip

 

Mail to:

 Terry Evert
6620 Bake Oven Road
Germansville, PA 18053

 

 

Donation $15.00  Driver

  $5.00 Donation passengers 12 and over.

 

Cash_____________           Check #___

 

Checks can be made payable to:  Wyatt S. Newhard