That Dam Ride to Confluence Sept 6-7, 2008 Entry Form
Release must be signed to participate - one rider per form.

Name……………………………………………………………………….Age…………

Address……………………………………………..City…………….………State….….

Zip Code…………Phone(………)………………..E-Mail................…...………….……..........

T-shirt size  XL  L M   S                                         XXL    $2.00 extra charge

Check Start location:  Boston     Connellsville   

Individual Registration July 1- August 21..….....................................................$65.00

                                     Tour de Confluence   ..................................$35.00 

Extra T-shirts…Sizes/Number______…….. each (add $2 for XXL).          ____________

TOTAL                                                                                                      $___________              

Camping at Dam? Yes         Breakfast sandwich?  Yes      for count only-pay at campground ($2.50)
In case of emergency call:___________________________________(____)_____-_______

Mail application and check payable to        MYTC That Dam Ride,  PO Box 14, Boston, PA 15135  

Release and Assumption of Risk: In consideration of my participation in That Dam Ride To Confluence or Tour de Confluence bicycle ride and camping trip on September 6&7, 2008, I, the undersigned, do knowingly and freely hereby agree to assume all risk of harm, injury, or loss, of whatever nature results at this event. I fully realize the dangers include, by way of example, and not limitation: the dangers of collision with fixed or moving objects, pedestrians, other riders and vehicles; the negligence of other riders, sponsors, promoters, or volunteers; equipment failure; road surface; weather conditions; and the possibility of serious injury associated with cycling. I, for myself, my heirs, executors, administrators, legal representatives, assigns, and successors, hereby waive, release, and discharge, and hold forever harmless Mon Yough Trail Council, volunteers, sponsors, public entities, property owners, representatives, and successors associated with this event, with respect to any and all damages, injuries, and claims which might arise from my participation or from traveling to or returning. I grant permission to all of the foregoing to use any photographs, or any other records of this event for any legitimate purpose. I represent that I am in sound medical condition and have no physical impediments that would endanger others or me. I accept responsibility for the condition and adequacy of my bicycle and safety equipment. I will wear an ANSI or SNELL certified helmet when riding a bicycle during That Dam Ride or Tour de Confluence. I will obey all Trail Rules and Pennsylvania laws and regulations. I understand that if I leave the designated route, I will no longer be a Ride participant and forfeit all privileges of the event. I acknowledge that entry fees are nonrefundable and non-transferable for any reason. This agreement may not be modified orally and may not be waived in any respect. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without coercion.