ENTRY FORM
Rain or Shine, We’ll Ride! Please print or place stickers
Name:____________________________________ Age:______ Sex:________
Address:_________________________________________________________
City:______________________________ State:_________Zip:_____________
Phone: Day: (_____)_________________ Evening: (_____)________________
In case of emergency contact:
Name:_________________________________Telephone (_____)___________
E-mail address:____________________________________________________
I am riding (circle one):
100 mi 66 mi 50 mi
ENTRY FEES:
50, 66 or 100 miles:
15 or 25 miles:
Family Ride:
25 mi
15 mi
15 mi Family Ride
$50.00 Includes 1 deluxe long sleeve T-shirt
$40.00 Includes 1 deluxe long sleeve T-shirt
$40.00 Includes 1 deluxe long sleeve T-shirt
(All family members must sign this release form. Make additional copies as needed.)
Additional T-shirt size: S_______M_______L_______XL______XXL_____
Make checks payable to: SANWRC
and mail to: Spokane Aurora Northwest Rotary Club
P. O. Box 18583, Spokane, Washington 99228
Questions about registration? Call Bruce @ (509) 466.6756
E-mail: [email protected] • REGISTER AT: ACTIVE.COM
RIDE INFORMATION:
• Helpful people to answer questions at the start and at each check point.
• Clearly marked and marshalled routes. You won’t get lost!
Please tell us how you heard about our ride.  Print  Web  Friend  Other
*** Registrations postmarked after April 9, 2015 are subject to a late fee .
Late Registrations will be receive a T-shirt 30-60 days after the event.
IT’S A RIDE, NOT A RACE
Helmets required for all participants
Spokane Aurora Northwest Rotary
P. O. Box 18583
Spokane, WA 99228
Registration forms available at www.northdivision.com
Credit card registration thru www.active.com
REGISTER ONLINE AT: ACTIVE.COM
T-shirt size: S________M________L________XL________XXL________
_____50, 66 or 100 miles @ $50.00 each $__________
_____15 or 25 miles @ $40.00 each
$__________
_____15 miles Family Ride @ $40.00 per family $__________
_____Additional deluxe long sleeve T-shirts @ $17.00 ea $__________
_____Trek Mountain Bike Raffle Tickets @ $2.00 each $__________
_____Potato Feed $ FREE _____Triathlete “Brick” Run @ $5.00 each $__________
_____ LATE Registration*** (after 4/9/15) $10.00
$__________
TOTAL$__________
ABOUT THE RIDE
RELEASE AND WAIVER OF LIABILITY
AND ASSUMPTION OF RISK AGREEMENT
DON’T MISS OUT!
Lilac Century bike drawing for a Trek 7.1 FX Bike, sized to fit, with
helmet, bottle and cage. Provided by North Division Bicycle. Value of
$500.00! If you would like to enter the drawing, please enclose an
extra $2.00 (see registration panel.)
Tickets will be issued at the packet pick-up. You may also purchase
tickets at the packet pick-up. Need not be present to win!
Spokane Aurora Northwest Rotary
P. O. Box 18583
Spokane, WA 99228
509.466.6756
LILAC CENTURY • FAMILY FUN RIDE
SUNDAY, APRIL 26, 2015
The 100-mile Ride and part of our 50-mile ride will travel along
the West Spokane River, the Long Lake Area and through the West
Plains of Spokane. The 66-mile route follows the Centennial Trail to
Nine Mile, around Long Lake, back to Nine Mile and then return to
SFCC. The 15 and 25-mile family rides follow the Aubrey L. White
Parkway on the west side of the Spokane River to the Seven Mile
or Nine Mile area and back. Each ride includes food stops! Maps
available at www.northdivision.com
START AND FINISH
START, FINISH AND PACKET PICK-UP
Spokane Falls Community College
3410 W. Fort George Wright Drive, Spokane, WA 99224
Building 17, Student Union, South Entrance
Northeast Corner of Parking Lot #9
LATE REGISTRATION AND PACKET PICK-UP
Saturday, April 25, 2015 • 5:00 pm to 7:00 pm
Sunday, April 26, 2015 • 6:30 am to 10:30 am
REGISTER ONLINE AT: ACTIVE.COM
100 Mile Start 6:45-7:30 a.m.
66 Mile Start 7:45-8:30 a.m.
50 Mile Start 9:00-9:30 a.m.
25 Mile Start 10:30 a.m.
15 Mile Start 10:30 a.m.
EVENT: LILAC CENTURY
FOR GOOD AND VALUABLE CONSIDERATION, including permission to participate in the Lilac
Century bicycle ride and the other related activities included, hereinafter “the event,” I,
for myself, any minor child I allow to ride in the event and our successor, heirs, assigns,
executors, and administrators:
1. AGREE that prior to participating I will inspect the facilities, equipment, and areas to
be used, and, if I believe any of them are unsafe, I will immediately advise the person
supervising this event, activity, facility, or area:
2. CONSENT TO MINOR’S PARTICIPATION. I hereby consent to the participation by any
minor I allow to participate in the event and agree that prior to our participation in the
event, the minor and I will inspect the facilities, equipment, and areas where the event
or activity is being conducted and, if either of us believes any of them are unsafe, I will
immediately advise the person supervising this event, activity, facility or area:
3. ACKNOWLEDGE that any minor I allow to participate and I fully understand that our
participation may involve risk which may result not only from our own actions, inactions,
or negligence,but also from the actions, inactions, or negligence of others, the condition
of the facilitates, equipment, area, terrain, vehicular traffic, weather, lack of hydration,
where this event or activity is being conducted, the rules of play, or this type of event
or activity;
4. ASSUME any and all risks of personal injuries to myself or any minor child I allow to
participate in the event, including medical or hospital bills, permanent or partial
disability, death, and damage to my property, or the property of any minor I allow to
participate in this event, caused by or arising from our participation in the event;
5. COVENANT not to sue or present any claim for personal injury, property damage, or the
wrongful death of myself or any minor child I allow to participate in the event against
Aurora Northwest Rotary, the City of Spokane, the County of Spokane, and their officers,
employees, and agents attributable to our participation in the event;
6. WARRANT that any minor child I allow to participate in the event is and I am in good
health and have no physical condition that would prevent us from participating in the
event;
7. By signing this release I also grant Aurora Northwest Roatary the rights and use of any and
all photographs, slides, and videos taken during the event of the person named on this
release for use in marketing and event promotion.
8. RELEASE, waive and discharge Aurora Northwest Rotary, the City of Spokane, the County
of Spokane, and their officers, employees, and agents from any liability, loss, damage,
claim, demand or cause of action against them attributable to the minor’s and my
participation in the event, whether the same shall arise by their negligence or otherwise
or our negligence or otherwise;
I HAVE READ THIS DOCUMENT, UNDERSTAND THAT I WILL GIVE UP
SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN VOLUNTARILY.
PRINTED NAME:_________________________________________________
SIGNATURE:_____________________________________________________
DATE:__________________________________________________________
Is it OK to contact you via your listed email address? _____Yes _____No