Registration Form - STOKR 2015 SCENIC TOUR OF THE KOOTENAI RIVER SATURDAY & SUNDAY, MAY 9 & 10, 2015 This year entry to STOKR will be a lottery system. For those of you who wish to ride with particular friends, gather your applications and money due and include UP TO 10 hopeful riders in one envelope. We will not be looking at postmarks. Applications received on or before March 10 will be entered in the random drawing. If you don't get in, your check will be torn up. If you would want your check returned, enclose a self-addressed stamped envelope. Name (print): _________________________________________________________________________________ Mailing address: _________________________________________________ Phone: _______________________ City/State/Zip: ________________________________________________________________________________ Emergency Contact: _______________________________________________ Phone: ______________________ Email address for confirmation purposes ___________________________________________________________ Ride Options: Check Option & enter price in Registration Fee ____ Option 1 - Ride both days, May 9 & 10 - $60 Saturday Ride, May 10 (check one) ___ 98 Mile Ride ___ 45 Mile Ride ____ Option 2 - Ride Saturday May 9 only - $55 (check one) ___ 98 Mile Ride ___ 45 Mile Ride ____ Option 3 - Ride Sunday, May 10 Only - $25 Registration Fee (see options) $_________ STOKR t-shirt ____ Size S @ $15 ____ Size M @$15 ____ Size L @ $15 ____ Size XL @ $15 ____ Size XXL @ $17 ____ Size XXXL @ $19 __________ __________ __________ __________ __________ __________ Optional Donation to Habitat for Humanity __________ TOTAL __________ _____ I would like to work on the Habit House on Friday, May 8 Please make check payable to: KVP Habitat for Humanity and mail to: STOKR, 1020 Idaho Ave, Libby, MT 59923. Cancellations received by April 26 will be refunded $20. The vacancy can only be filled from the wait list. CANADIAN RIDERS - Your payment must be an international money order or a check drawn off of a US bank. Waiver/Release Form I understand a helmet is required to be worn at all times while riding in the Scenic Tour of the Kootenai River (STOKR). I agree to abide by the safety precaution requirements and all other rules for STOKR presented to me by the Kootenai Valley Partners Habitat for Humanity. I agree to indemnify and hold harmless Kootenai Valley Partners Habitat for Humanity from all cost, expense and liability arising out of my participation in STOKR. I hereby waive all claims for damage or loss to my person or property which may be caused by any act or failure to act by Kootenai Valley Partners Habitat for Humanity, its officers, agents, or employees arising directly or indirectly from my participation in STOKR, and I hereby assume liability for any loss, damage or other liability fromSTOKR. I give my permission for medical release should I be involved in any accident or health damaging situation, and should I require treatment. Participant's Signature ___________________________________________________ Date _______________________ Participant's under 18 years of age must have this additional waiver/release form signed by a parent or guardian I have read and understand the complete waiver/release form, and the rules of STOKR. I request that my son/daughter be allowed to ride in STOKR. I understand that children under 18 years of age must be accompanied by an adult. I explained the rules to my son/daughter and agree that Kootenai Valley Partners Habitat for Humanity, it's officers, agents, or employees will not be responsible for my son/daughter while riding STOKR. I also give my consent to the medical release clause in the completed waiver/release form. ` Parent or Guardian's Signature ______________________________________________Date _______________________