To Pre-register mail prior to April 15^th 2003 to:

(Only Pre-registrants will receive T-shirt)

Wallkill Hook Ladder & Hose Co./Bike Tour

P.O. Box 789

Wallkill, NY 12589-0789

$25.00 Registration fee includes the BBQ dinner:

Sunday April 27, 2003

(Rain date: May 4, 2003)

Sorry, no refunds

Name:

Add:

City:

State: Zip:

Date of birth:

Helmets are Mandatory for all events

Please indicate T-Shirt Size:

šS šM šL šXL šXXL

Please indicate intended ride(s):

š15mi š35mi š50mi šTime Trial

I, on behalf of myself, my heirs, distributors, next of kin, personal representatives, executors, administrators, and assigns, do hereby release and discharge the Wallkill Hook Ladder & Hose co, Inc, and members, Hospice, Lions Club, Breast Cancer Awareness and sponsoring agencies, businesses, persons and organizations and their agents from any and all liability claims or damages, demands, actions and causes of actions whatsoever, in any manner arising out of or relating to any loss , damage or injury, including death that may be sustained by the undersigned, or any property of the undersigned while participating in the event. I also give my full permission for the use of my name and photograph in connection with this event. I further understand that wearing an approved helmet is mandatory to participate in this event.

Print name

Signature MINIMUM AGE FOR THE TIME TRIAL IS 16!!

(Parent signature if participant is under 18 years of age)