DANCING BEAR BICYCLE BASH

April 4 - 6, 2007

Registration Form:
Please fill out all information below.

*First Name:
*Last Name
*Email Address:
*Address1:
Address2:
*City:
*State:
*Zip:
*Phone: (Home)
(Cell):
*Emergency Contact:
*Phone:


List all additional participants:
Name:
Riding:
 Yes  No
Name:
Riding:
 Yes  No
T-Shirt Size:
SM
MD
LG
XL
XXL
Rider #1:
Rider #2:
Rider #3:

*Costs: (room and cabin costs include two nights lodging, reception and post ride party)
Choices 
Price
Qty.
  
Lodge Room:
$390
     
One bedroom cabin:
$450
     
Two bedroom cabin:
$600
     
Riding Registration Guest (riding and t-shirt):
$15
     
Local Riding Registration
(riding, t-shirt and post ride party):
$35
     
Total:
Visa, Master Card or Discover Accepted. Checks accepted for non-guest registration. Please make check payable to: Maple Leaf Lodge, LLC
Liability Release: I fully realize the risks involved with participating in an organized bike ride. I fully assume all risks associated with participation in the “Black Bear Bicycle Bash”. I hereby waive, release and discharge myself, my heirs, etc. any and all rights and claims which I have or which may hereafter accrue to me against the sponsors and organizers of the “Black Bear Bicycle Bash” and against Maple Leaf Lodge, LLC. I agree to abide by all the applicable laws and regulations. I will wear a Snell or ANSI approved helmet at all times when on the bike. I accept responsibility for the condition of my equipment. I agree that the above representations are contractually binding. I will accept and assume responsibility for my actions.
I understand that a cancellation refund of the total fee minus twenty-five dollars is available until March 4, 2008.
*By checking this box you acknowledge that all riders in your
party have read and agree to the disclaimer above: