Registration Form
Credit Unions for Kids Ride & Rock
Sponsored By: Fibre Federal Credit Union & iQ Credit Union
Event Date: Saturday, August 22, 2015
REMEMBER TO SUBMIT YOUR RIDE REGISTRATION AND LIABILITY FORM BY FRIDAY, JULY 31, 2015 TO RECEIVE A FREE
“CREDIT UNIONS FOR KIDS RIDE & ROCK” T-SHIRT AND $5 DISCOUNT OFF OF YOUR REGISTRATION FEE.
PACKAGES
A.
PRICING
TOTAL
* $60.00
PARTICIPANT PACKAGE
Ride, Lunch, Pin, (1) Poker Hand, (1) Concert Ticket, Dinner
*Remember to include $5 discount if registration and “Release of Liability” received by 07/31/15
B.
* $60.00
PARTICIPANT PASSENGER PACKAGE
Ride, Lunch, Pin, (1) Poker Hand, (1) Concert Ticket, Dinner
*Remember to include $5 discount if registration and “Release of Liability” received by 07/31/15
C.
CONCERT PACKAGE – Purchase by 08/20/15
$35.00
Concert Ticket & Dinner (Dinner not included if purchased after 8/20/15 or at the door)
D.
RIDE & ROCK T-SHIRT
$20.00/EACH
If you would like a T-Shirt but missed the 07/31/15 deadline, you may still purchase one.
T-Shirts ordered after 07/31/15 will be available for pick-up by 09/30/15.
E.
ADDITIONAL POKER HANDS
$15.00/EACH
F.
RIDE & ROCK BEAR
$10.00/EACH
TOTAL ENCLOSED
PARTICIPANT INFORMATION
PARTICIPANT PASSENGER INFORMATION
Name:
Name:
Address:
Address:
City/State/Zip:
City/State/Zip:
Phone:
Phone:
Email:
Email:
T-Shirt Size
T-Shirt Size
S
M
L
XL
2XL
3XL
4XL
IN ORDER TO RECEIVE A FREE T-SHIRT
REGISTRATION IS REQUIRED BY 07/31/2015.
S
M
L
XL
2XL
3XL
4XL
IN ORDER TO RECEIVE A FREE T-SHIRT
REGISTRATION IS REQUIRED BY 07/31/2015.
To qualify for $5 discount and a free t-shirt, registration form, along with payment and “Release of
Liability” must be received on or before Friday, July 31, 2015.
Please make checks payable to “iQ for Kids” and mail to:
Fibre Federal Credit Union, ATTN: Monica Anderson, PO Box 1234, Longview, WA 98632.
Release of Liability
Event Name:
Credit Union for Kids Ride & Rock
Event Date:
August 22, 2015
THIS IS A RELEASE – READ BEFORE SIGNING!
The below named participant or participants (“Participant”) understands that this event involves riding on a
motorcycle (“Motorcycle Riding”) on a predetermined route, and that Motorcycle Riding can be hazardous.
Participant understands that property damage, injuries and death are common when Motorcycle Riding.
Participant accepts and assumes all risks associated with Motorcycle Riding, including, but not limited to,
weather, road conditions, traffic conditions, mechanical or tire failure, collisions with natural or man-made
objects or pedestrians, loss of control, loss of or diminished visibility, negligence on the part of Participant or
others, route selection and failure to ride within one’s ability. Participant is the sole judge of his/her ability to
participate in Motorcycle Riding and in this event. Participant is aware of the route chosen for this event and has
had the opportunity to examine such route. Participant expressly assumes all risk of property damage, injury or
death associated with Motorcycle Riding and this event.
In consideration for participation in this event and Motorcycle Riding, Participant hereby agrees to release,
hold harmless, and indemnify Credit Unions for Kids, iQ for Kids, iQ Credit Union, and Fibre Federal Credit
Union and their respective employees, members, officers, directors, volunteers, and agents (collectively, the
“Released Parties”) from any and all claims by or on behalf of Participant against the Released Parties arising
directly or indirectly out of Participant’s participation in this event and/or Motorcycle Riding. This release
includes claims arising from any cause whatsoever, including, but not limited to, negligence on the part of the
Released Parties. Participant also agrees to indemnify (including costs and attorney fees) the Released Parties
for any claim brought on behalf of any minor named below.
Participant understands that the Released Parties make no guarantees, warranties, or representations about the
condition, safety, or quality of any route chosen for this event and/or Motorcycle Riding.
Participant represents and warrants that he/she has sufficient experience to participate in this event and
Motorcycle Riding, that he/she has all appropriate insurance, that he/she will abide by all applicable laws
(including helmet laws), and that his/her motorcycle is properly licensed and registered, that he/she has a valid
drivers’ license with a valid motorcycle endorsement, and that he/she is 18 years of age or older.
Participant agrees that any images taken during this event may be used for any purposes associated with this or
any future events.
This release shall be governed and interpreted by Washington law.
Participant has read this release and fully understands it.
Participant Signature
Date
Participant Passenger Signature
Please print clearly. Passenger must sign form in order to ride.
Participant Name:
Participant Passenger Name:
Address:
Address:
City/State/Zip:
City/State/Zip:
Date