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Tour de LaMec

Sponsored by
Lawrence County Cycling Club
lccconline.com
August 17, 2014
Marti Park, New Wilmington, PA

Tour de LaMec is a scenic ride on lightly traveled roads in Lawrence and Mercer Counties held at Marti Park, 604 Phillips School
Rd, New Wilmington, PA 16142. Registration opens at 7:30 am, riders may leave anytime after 7:30 am, rain or shine. Riders
planning to ride all four loops, 100 miles, must leave by 8 am. Each 25 mile loop begins and ends at Marti Park, drinks, snacks and
hot food will be supplied for all riders. Riders will be sag supported until 4 pm. Proceeds support local bicycling. See our website at
LCCConline.comfor directions and more information

F o r y o u r S a f e t y A N S I o r S n e l l H e l m e t s A R E r e q u i r e d t o R i d e i n
t h i s T o u r !

Please print – fill out completely and sign waiver – one form per rider – may photocopy

Name ____________________________________________________________________________________________

Address__________________________________________________________________________________________

City/State/Zip _____________________________________________________________________________________

Phone _____________________________________________ Email ________________________________________

I am under 18 year of age - YES_____ NO_____, if Yes, parent or guardian must sign below.

Select ride length: 15 miles _____ 25 miles_____ 50 miles_____ 75 miles_____ 100 miles_____

$15.00 Pre-registration due by July 30, 2014 $ 15.00
Registration after July 30, 2014 and day of Ride will be $ 20.00

Pre-Registered Group Rate - 5 or more riders (number of riders ____x $12.00 ea.) $______ total group

Long-Sleeve T-Shirt: Sm___ Md___ Lg___ XL___ XXL___ $14.00 ea. pre-ordered $ ______
Day of Ride T-Shirts $16.00 Total Enclosed $ ______

Checks Payable to: Lawrence County Cycling Club Mail to: 1907 W State Street, New Castle, PA 16101. For more
information call: John Kwiat, Phone 724-652-3434, Email: jrkwiat@msn.com

Rider’s Signature _________________________________________________________________ Date ___________________________

If under 18 Parent/Guardian Signature _______________________________________________ Date ___________________________
Liability Release—I voluntarily request permission to participate in the 2010 Tour de La Mec, UNDERSTAND THE HAZARDOUS NATURE OF THIS ACTIVITY
AND ACCEPT FULL RESPONSIBILITY FOR MY PARTICIPATION AND THE RISKS INVOLVED including, by way of example and not limitation, dangers of
collision with pedestrians, vehicles, other cyclists and fixed or moving objects, dangers arising from surface hazards, equipment failure, inadequate safety equipment,
the released parties’ negligence, weather conditions and the possibility of serious physical and/or mental trauma or injury. I have no physical or mental condition, to my
knowledge, which would endanger myself or others, or would interfere with my participation. I have inspected all my personal equipment to be sure it is in good and
safe condition. I agree to abide by all applicable laws and regulations and to act in a safe and courteous manner. I acknowledge that is mandatory that I wear an ANSI
or Snell approved helmet at all times while bicycling in the Tour de La Mec. Inconsideration of permission to participate in Tour de La Mec for myself, my heirs,
executors, administrators, legal and personal representatives, successors, and assigns, I DO HEREBY DISCHARGE, RELEASE, HOLD HARMLESS, PROMISE
NOT TO SUE AND INDEMNIFY THE LAWRENCE COUNTY CYCLING CLUB, its officers, volunteers, and any other organizations including sponsors,
associations, municipalities, or individuals connected with Tour de La Mec from any and all claims, demands, rights, actions or causes of actions of whatsoever kind
and nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property and all the
consequences thereof which may hereafter be sustained by my participation in Tour de La Mec. In addition, I hereby consent to emergency treatment in the event of
injury or illness.
…………………….. “Share the Road”