Your hotel room after maid service
State Street in the rain.  
Locally distilled at the Old Sugar
Factory Distillery.


                                                      WAIVER & RELEASE
                                                 "Madison Memories Bicycle Tour"
                                                  August 19 - 26, 2012


    This document could affect your rights.  
    Please read, sign and return with your registration fee:
       .......... $175 With Jersey
     .......... $125 Without Jersey
    To: Richard Sheff, 10 Harborcrest, Irvine, CA 92604
    Form to be signed by all participants (riders & non-riders.)  

    I, the undersigned, understand that every effort will be made to make this event as safe as possible.  
    I know that bicycling & hiking can be dangerous.  I participate in this event and all the activities
    associated with it with full knowledge and acceptance of all the risks and assume full responsibility
    for my own safety during the event.

    I agree to hold harmless everyone associated with the "Madison Memories Bicycle Tour"  held
    August 19 through August 26, 2012, its agents and assigns, from any and all liability, claim or action
    from, or arising in any way out of, my participation in this event.

    A helmet is required to participate on all the bicycle rides.

    Have a great tour and a safe ride or hike!

               SIGNATURE                                   PRINT YOUR NAME                 DATE

    X________________________________              ___________________________        __________


    X________________________________              ____________________________       __________
             
      YOUR CELL PHONE NUMBER

                   1.  (     )


                   2.  (     )

         E-Mail Address
    1.

    2.

              Emergency Contact                              Telephone Number

                                                                                                    area code
     Print Name..........................................................                   (         )
WAIVER & RELEASE