2007 Big Ring Flyers Time Trial Challenge Registration Form                         Internet Version                     

Last Name                                                                     First                                                         Age on July 1^st         Birth Date                      Sex

Address                                                                                                                City                                                 State                    Zip

Checks payable to - BIG RING FLYERS BICYCLE CLUB                        Mail to: Bob Barabe, 522-B 8^th St. N., Hudson, WI 54016

Check one below:                                                                       Check one below:                                           Check one below:                          

$25 Early Registration 8/1/07                                               Road Bike                                                    Current Wisport member

$30 Normal Registration                                                       Tandem Bike                                               Not Wisport member

Family Rate, list members on additional forms or additional paper.

I will participate in the Big Ring Flyers Time Trial Challenge, and thereby waive, release and dismiss all claims from damages and personal injury of which I may incur before, during, or after the Big Ring Flyers Time Trial Challenge, against any and all race officials involved in the Big Ring Flyers Time Trial Challenge, including all persons and organizations, and the Bass Lake Cheese Factory owner who may be in any way involved with the race, I also hold harmless the Townships of Somerset, Richmond and St. Josephs, including all departments and persons and the Hudson Lion’s Club.  I further certify that I am physically fit to participate in the Big Ring Flyers Time Trial Challenge and understand that bicycling is a potentially dangerous activity.

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                      Signature of Participant                                                         Date                                If under 18, Signature of Parent or Legal Guardian