CycleFlagler: Register

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Cycle Flagler Registration

(using PayPal credit care processing)

(* indicates a required field)

First Name*:
Middle Name:
Last Name*:
Gender*:
Date of Birth (mm/dd/yyyy)*:
Email Address*:
Enter email again*:
Phone*:
Mobile:
Address*:
Address Line 2:
City*:
State*:
Zip*:
Tell your friends and family about this event!:	(List email addresses separated by commas)
Tourlength*:
Overnight Accommodation:
Emergency Contact Name*:
Emergency Contact Phone*
Will you stay for the FREE old-fashioned picnic?:
Tee Shirt Size: (First 400 registered cyclists only) Note: this close to the event date, specified sizes cannot be guaranteed
Voluntary donation to Rotary Club of Flagler Beach?:
Please read this waiver carefully. It includes a release of liability and waiver of legal rights and deprives you of the ability to sue certain parties. Do not agree to this document unless you have read and understood it in its entirety. By agreeing electronically, you acknowledge that you have both read and understood the text presented to you as part of the registration process. You also understand and agree that events carry certain inherent dangers and risks which may or may not be readily foreseeable, including without limitation personal injury, property damage or death. Your ability to participate in the event(s) is/are subject to your agreement to the waiver and by agreeing herein, you accept and agree to the terms of the waiver and release agreement.
By indicating your acceptance, you understand, agree, warrant and covenant as follows: In consideration of this entry and participation in this event, we do hereby forever release and discharge the Rotary Club of Flagler Beach, their directors, agents, membership and any person or corporation connected herewith from all manner of action, injury, damages, costs, claims or demands which we shall or may hereafter have, suffer or receive by reason of such participation in this event or associated activities. The release shall be binding on our heirs, assigns, executors and administrators. I consent to permit emergency medical treatment as needed at my expense. I further agree to follow all applicable traffic laws, conduct my activities in a safe and prudent manner, wear an approved helmet and not use headphones. BY INDICATING YOUR ACCEPTANCE OF THIS AGREEEMENT AND WAIVER, YOU ARE AFFIRMING THAT YOU HAVE READ AND UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS. YOU UNDERSTAND THAT YOU ARE GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE. YOU ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
I agree to the above waiver::