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Lincoln
Circuit Ride
Name: ______________________________________________________________
Address: ____________________________________________________
___________________________________________________________
___________________________________________________________
Phone: _______________________________
Emergency Contact:
Name________________________________ Phone: __________
Liability
Waiver:
In registering for CU
Across the Prairie, I hereby release and waive all claims against the
Prairie Cycle Club
(PCC), Champaign Historical Museum, and Champaign County bikes, theirofficers
and members, successors and
assignees, for any damages resulting in injury either to myself or to
my equipment during the abovenamed
event.(Individuals
under the age of 18 must add the signature of a parent or legal guardian
to ride with the Lincoln Circuit Ride
_______________________________________________________
Signature and date
Preregistration:
$10 Day of ride: $15 (proceeds after cost go to the
Champaign Historical Museum)
Make checks payable to Prairie Cycle Club $ ___.00 enclosed
Prairie Cycle Club
P.O. Box 115
Urbana, IL 61801
Email: Lincolnbikeride@gmail.com
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