Print this registration form, fill it out, sign the Waiver and mail it with the appropriate funds to:

Southwest Tandem Rally

Bob and Jo Carol Williams

7721 S. 28th West Avenue

Tulsa, OK  74132

Captain Name: _________________________________________________________         Meal Options Vegetarian ( ) or Meat ( )

Stoker Name:   _________________________________________________________        Meal Options Vegetarian ( ) or Meat ( )

Address:  __________________________________________________       Phone Number :  __________________Cell Phone:__________________

City, State, Zip:  ____________________________________________         Email: _____________________________

Emergency Contact Name: ____________________________________         Tandem Make, Model, Color: ____________________________

Emergency Phone Number:  ___________________________________         _____________________________________________________

List ALL children that will be attending the rally and their ages on April 1, 2008:

#1 Child’s Name and Age:__________________________       #2 Child’s Name and Age:_________________________

      Meal Options   Vegetarian ( ) or  Meat  ( )                                           Meal Options   Vegetarian ( )  or Meat  ( )

Cost:  (does not include lodging)

Tandem team (captain and stoker)……….$____               (postmarked before _______)…$__________

Children ages 5 to 12 (on 4/1/08)………….$____              per child……………….......……$__________

Children ages 0 to 5 …………………………………………………………….....................…$ FREE

TOTAL ENCLOSED: (PLEASE MAKE CHECKS PAYABLE TO SOUTHWEST TANDEM RALLY)…....$__________

The Fine Print – Waiver:  In consideration of your allowing me to participate in the Southwest Tandem Rally, I, intending to be legally bound, release and discharge any and all claims for damages, death, personal injury or property damage, which I may have, or which may hereafter accrue to me, as a result in my participation in this event.  This waiver/release is intended to discharge in advance the Southwest Tandem Rally, and its organizers from and against any and all liability arising out of or connected in any way with my participation in the Southwest Tandem Rally, even though that liability may arise out of negligence or carelessness on the part of the Southwest tandem Rally, or its organizers.

I further understand that serious accidents occasionally do occur on bicycle rides and that participants occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence.  Knowing the risks, nevertheless, I hereby agree to assume those risks and to release and hold harmless the Southwest Tandem Rally and its organizers, who (through negligence or carelessness) might otherwise be liable to me for damages or injuries.  It is further understood and agreed that this waiver, release and assumption of risk is binding on my estate, my heirs, and assigns.  I agree to abide by all applicable laws and regulations.  I will wear a Snell or ANSI approved helmet.  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 partial refunds are available until March 1, 2008 and that there are NO refunds after March 1, 2008.  I also understand that there is a $20 charge for each refund.

Captain signature:  _______________________________________            Stoker signature:  ______________________________________________

Date:________________                                                                                 Date: ____________

Signature of parent or adult for children under 18:  __________________________________________________

Date: ________________________