PRINT THIS FORM, FILL IT OUT 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 Number:  ____________________________

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:____________________

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 CPSC 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:  ___________________________

Signature of parent or adult for children under 18:  ____________________________________