Tour de Poway Registration Form

Print this form and mail or fax back, a signature is required on waiver below.

Name________________________________________________________________________

Address ______________________________________________________________________

City ________________________State__________ Zip __________Phone _________________

Please check course: __ 15 Miles ___25 Miles ___50 Miles ____ Metric Century(65 miles)

========================================================================================

1) Registration fee thru October 3rd($25)........................$___________

Free T-shirt circle size,S---M---L---XL---XXL(ADD $5)

2) Riders under age of 12 ($20)................................. $___________

3) Tandem ($45) ........................................................$___________

4) After October 3rd add ($5)............................................$___________

5) Lunch Ticket ($8)---------------------------------- $___________

6) Extra T-shirt ($10 ea.)ADD $5 for XXL------------$____________

circle size S---M---L---XL---XXL

7) TOTAL (DO NOT SEND CASH) ...................... $____________

Pay by credit card or check payable to, "TOUR DE POWAY" (NO REFUNDS)

Credit Card # ________________________________________Expiration Date_____________

7) Send registration form and SASE(self addressed stamped envelope)for ride bib and map to:

TOUR DE POWAY, P.O. BOX 1446, POWAY, CA. 92074 (Fax # 858-486-4202)

Waiver and Release: In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators waive any and all rights and claims for damages I may have against Kiwanis Club of Poway, Kiwanis Internatinal, Cycling Promotions West, Sponsors, coordinating groups, and any individuals asscociated with this event, their representatives, successors and assigns, and will hold them harmless for any and all injuries and/or damages suffered in connection with this event. I have been warned that bicycling is a dangerous sport and that I must be in good health to participate in this event. I must obey all traffice laws and it has been recommended to me that I should wear a helemt while participating in this event. In filling out this form I acknowledge I have read and fully understand my own liability and do accept the restrictions.

X____________________________________________ Date______________________

Signature of participant (or signature of parent/guardian if under 18 years old)