Registration
SPINDLETOP SPIN REGISTRATION FORM
June 5, 2010
Where did you hear about the Spindletop Spin? _________________________________________
Does your plan include a stay in a local hotel? _________ If yes, what hotel?________________
______________________________________________________________________________
Name
Age
Age______________________________________________________________________________
Street Address
______________________________________________________________________________
CityStateZip CodePhone Number
StateZip CodePhone Number______________________________________________________________________________
In case of emergency, notifyPhone Number
Phone Number______________________________________________________________________________
E-mail address
______________________________________________________________________________
Medical Conditions/Allergies
I fully understand that my participation in the Spindletop Spin Bicycle Ride could result in serious injury, illness or death. Although I fully appreciate these risks, I desire to participate without regard to the consequences. I waive all claims I may have against Spindletop Spin Bicycle Ride, the city of Beaumont, The Jefferson County Bar Association Foundation, The Jefferson County Bar Association, or any individual, firm or organization resulting in whole or part from my participation in the Spindletop Spin Bicycle Ride. This waiver shall be binding on my heirs, administrators, and successors. Further, I hereby grant full permission to any and all foregoing to use photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Entrant’s Signature ______________________________________________ Date __________
(Parent must sign if rider is not 18 years old)
No refunds – ride is in rain or shine.
Date:June 5, 2010
June 5, 2010Place:Crockett Street Entertainment District, Beaumont, Texas 77701
Crockett Street Entertainment District, Beaumont, Texas 77701DIRECTIONS: I-10 to Beaumont (either direction) take the downtown exit, turn left at the second light, which curves and turns to Main Street. You’ll go through two stop lights and then one block down will be Crockett Street on the right.
Circle Distance: 16 miles 30 miles 52 miles100 miles (Approximate Distances)
30 miles 52 miles100 miles (Approximate Distances) (8:00 am) (7:30 am) (7:30 am) (7:00 am)Start times are ride out times. Registration Opens at 6:00 am
Circle T-shirt size:SMMEDLGXLXXLYouth: SMMEDLG
SMMEDLGXLXXLYouth: SMMEDLGT-shirts for paying riders ONLY. Additional shirts can be ordered for $10.00. On site registrants will be given shirts while supplies last.
Fees:
Individual:Contributions over the value of the luncheon ($10) are tax deductible. Family Ride:$25 1st parent, $15 2nd parent, children under 18 ride free. 16 mile ONLYFamily constitutes parent(s) & minor child/children TOTAL Amount Enclosed: Entry Fee/additional children(s) shirt(s)_______________________
Make checks payable to: Jefferson County Bar Association Foundation (JCBAF)
Registration On Line: www.active.com
Mail registration forms to: Jefferson County Bar Association Foundation, 1001 Pearl Street, Room 202, Beaumont, Texas 77701
Helmets required. “Protective bicycle helmet” means headgear that meets or exceeds the impact standards for protective bicycle helmets set by the United States Consumer Product Safety.
SAVE THE DATE JUNE 4, 2011 6th Annual Spindletop Spin
