ENTRY FORM
One person to a form. Form may be duplicated. Please print and return by mail
by May 23, 2008 the T-Shirt order deadline.
Name _____________________________________________________________________
Address ____________________________________________________________________
___________________________________________________________________________
City ___________________________________ State ___________ Zip _______________
Phone(s) (_____)_________________________ (_____)____________________________
Email ______________________________________________________________________
Date of Birth ________/_________/________ Sex M / F Do You Have a Team? Y / N
Team Captain's Name _________________________________________________________
We'll assign you a team captain, if you don't have one. He/she will contact you.
Emergency Name __________________________ Emerg. Phone ______________________
T-Shirt Size (Indicate the number of each size ordered :
Sm_____ Med_____ Large_____ XL_____ XXL_____ XXXL_____
Ride Fee $25 ________ (Applied toward $250. Includes one T-shirt if submitted by 5/23/08)
Total raised toward the $250 _________ (Turn in to your team captain one week before the ride.)
Extra T-Shirts ($15) _______________ TOTAL ENCLOSED ___________________________
Make check payable and mail to:
The Exchange Network
PO Box 177, Columbia TN 38402
YOUR ENTRY CANNOT BE ACCEPTED WITHOUT YOUR RELEASE SIGNATURE.
RELEASE (Please read carefully and sign.)
In consideration of the acceptance of this application, I hereby, for myself, my heirs, executors,
administrators and assigns, and anyone entitled to act on my behalf, release and discharge The
Exchange Network, plus sponsors, their representatives and successors, directors, officials,
employees and volunteers, from any and all claims of injury or damages suffered by me as a result
of my participation in, or traveling to or from, the Turn the Tide 2008 bicycle ride.
I know that bicycle riding is potentially hazardous. I should not enter the Turn the Tide bicycle ride
2008 bicycle ride unless I am medically able and properly trained. I assume all risks associated with
riding in the Turn the Tide bicycle ride, including but not limited to: falls, contact with other
participants, the effect of the weather, traffic, and conditions of the road, all such risks being known
and appreciated by me. I realize that bicycling is a strenuous activity which requires proper physical conditioning.
I hereby certify that I am in such physical condition and good health.
_________________________________________________________ Date _____________
Signature of Rider
_________________________________________________________ Date _____________
Signature of Parent or Guardian (if rider is under 18)
Youth under age 16 must be accompanied by an adult. All riders must wear helmets.