Join
The Victory Ride
by clicking here
or by filling out this form and returning it to:
Connor's Army
PO Box 196
Northport, New York 11768
or to
15 Neil Court
Oceanside, New York 11572
Pledges are not necessary but can be accepted on or before April 18th, 2010.
Make sure pledge checks are payable to Sunrise Day Camp.
__________________________________________________________________________________________
Name
___________________________________________________________________________________________
Address
___________________________________________________________________________________________
Email Will you be doing the 13, 26 or 44 mile ride?
___________________________________________________________________________________________
Phone Fax
___________________________________________________________________________________________
Enclosed is my $25 registration and an additional donation of _______________________
(Please make registration and donation checks payable to Sunrise Day Camp)
q My employer has a matching gift program
You can also register or make pledges securely on-line by following the Victory Ride link at:
www.ConnorsArmy.org
q I'll be riding with Gene q I have goods or services to donate
q I'm creating a Victory Ride in my town q I want to volunteer
q I'm going to Ride in Spirit, here is my pledge q I want to sponsor Gene
WE HAVE TO PUT THIS PART IN: I know that riding a road course is a potentially hazardous activity and I assume all risks associated with riding in this event, including but not limited to falls, contact with other participants or spectators, the effect of weather including cold and precipitation, traffic and conditions of the road, all such risks being known and appreciated by me. Therefore, in consideration of your accepting this entry I, the undersigned, intending to be legally bound for myself, my heirs, executors, administrators and assigns waive and release any and all right and claims for damages I may have against Connor's Army, the American Cancer Society, the municipalities through which the event takes place, all sponsors, and their representatives, successors and assigns for any and all injuries suffered by me in said event and all claims for liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I attest and verify that I will participate in the event as a cyclist and that I am physically fit and have sufficiently trained the this event and that my physical condition has been verified by a licensed medical doctor. Further, I grant full permission to any and all of the foregoing to use any photographs, video/audio tapes, motion pictures, recordings or other records of this event for any legal purpose whatsoever.
_______________________________________________________________
Signature (Parent's signature if under 18) Date
