the Registration Package
CANADIAN OILFIELD RIDERS ASSOCIATION 27th ANNIVERSARY Run for the Children’s Wish Foundation June 20TH, 2015 Kids of Children’s Wish Overcome Challenges on a Daily Basis (we will overcome the weather if need be) All proceeds towards THE CHILDREN’S WISH FOUNDATION OF ALBERTA & other related charities ITINERARY Where: Chestermere (John Peake Park) to Wayne AB June 20th – 8:00 am – 10:00am Chestermere: Registration & Complimentary Breakfast 10:00am Departure 4:00pm Arrival @ Wayne (Free Camping available) Wayne Community Hall – Prizes & Dinner, Show & Shine, Entertainment (Free camping available and encouraged Friday-Sunday for those wishing to depart Sunday June 21st ) COST Does it Matter…it’s for the Kid’s - Pre-Registration Fee = $75.00 per person (Pre-registration fee must be received on or before May 30th, 2015 to receive 27th Pre-registration gift.) - Late or On-Site Registration Fee = $75.00 (you may register the day of the event) but you will not receive the 27th Anniversary gift. -Commemorative Shirt for first 250 Riders -There will be NO further solicitation the day of the ride for additional donations to the Children’s Wish Foundation. -There WILL be a limited raffle for additional prizes. -You do not have to ride to participate in this event, however because this is a fundraising event, Remember, this is a Non-Profit organization. You MUST register to participate. All Proceeds donated to the Children’s Wish Foundation ROAD RULES All Alberta highway laws apply. Participants MUST NOT drink and drive. REGISTRATION INCLUDES -Breakfast, Hot Dog Stop, Dinner, Entertainment -Free Camping in Wayne (Sunday Breakfast Provided) -Shuttle provided for those staying in Drumheller FOR MORE INFORMATION, CALL Canadian Oilfield Riders Association 5677 Burleigh Crescent SE Calgary, Alberta (403) 255-3730 Randy Pedersen: 403-804-2170 Laurie Germsheid: 403-200-0333 Mike Thibault: 403-601-3690 Laurie Meyers: Bill Karran: Tim MacTavish: 403-860-0674 403-815-8380 403-852-6837 RIDER REGISTRATION / RELEASE FORM If you would like to make a donation to the Children’s Wish Foundation (DIG DEEP… IT’S FOR THE KIDS!!), please do so with a separate cheque and submit it with the attached donation form. CANADIAN OILFIELD RIDERS ASSOCIATION – 27th ANNIVERSARY Run for The Children’s Wish Foundation SATURDAY, June 20TH, 2015 ENTRY FEE: $75.00 FOR PRE-REGISTRATION (before May 30th to receive 27th Anniversary Pre- registration Gift) $75.00 IF YOU REGISTER AFTER May 30th (or on the day of the event) You do not have to ride to participate in this event, however because this is a fundraising event, You MUST register to participate. For Pre-registration on line: www.canadianoilfieldriders.ca (PayPal available) or you may fill in the form below & mail to: Canadian Oilfield Riders Association 5677 Burleigh Crescent SE Calgary, Alberta T2H 1Z7 Phone: (403) 255-3730 A separate registration form must be filled out and a separate fee for both rider and passenger -- PLEASE PRINT CLEARLY – NAME: __________________________________________________ DATE:_____________________________ ADDRESS: ______________________________________________ CITY: ______________________________ PROV / STATE:___________________________________ POSTAL / ZIP CODE: ______________________ HOME PHONE: _________________________________ BUS PHONE: _____________________________ Email Address: _____________________________________________________________________________________ EMERGENCY CONTACT: ________________________________ PHONE: ___________________________ I hereby represent and certify that I am over the legal age of 18 years and the information I have given is true and correct. I recognize and understand that the Canadian Oilfield Riders, and the Children’s Wish Foundation of Alberta and the Co-Sponsors or their representatives (all being collectively referred to hereafter as “released parties”) are relying upon the accuracy of the information I am providing in allowing myself to participate in the above listed charity ride. I hereby state that I am experienced in and familiar with the operation of motorcycles and fully understand the risks and dangers inherent in motorcycling. I am voluntarily participating in the charity ride and I expressly agree to assume the entire risk of any accident or personal injury, including death that I might suffer as a result of my participation in the charity ride. I participate in the ride knowing the existing weather conditions, road conditions and other similar conditions and factors associated with this ride could be hazardous. For and in consideration for the opportunity to engage in the ride for charity, I (on my own behalf and on behalf of my heirs, personal representatives, successors and assigns) do hereby release and forever discharge the released parties (including their officers, directors, employees, agents and insurers) from any and all claims, demands, rights and causes of actions of any kind whatsoever which I now have, or later may have, known or unknown, in any way resulting from or arising out of, my participation in this ride. This release extends to any and all claims that I have or may have against the released parties whether such claims result from strict liability or negligence on the part of any of all of the released parties with respect to the design, manufacture, repair or maintenance of the motorcycle(s) which I will be riding during the charity ride, or with respect to the conditions, qualifications, instructions, rules or procedures under which the ride is conducted or from any other cause. However, I do not release any released party from any intentional misconduct on their part. BY SIGNING THIS RELEASE, I CERTIFY THAT I HAVE READ THIS RELEASE AND FULLY UNDERSTAND IT, AND THAT I AM NOT RELYING ON ANY STATEMENTS OR REPRESENTATIVES OF ANYONE RELEASED THEREBY. I have made my CHEQUE PAYABLE TO “CANADIAN OILFIELD RIDERS ASSOCIATION”. I will conform to all rules and regulations of the Canadian Oilfield Riders Charity Run. I WILL NOT OPERATE A MOTOR VEHICLE WHILE UNDER THE INFLUENCE OF ALCOHOL OR ANY OTHER ILLEGAL DRUG OR CONTROLLED SUBSTANCE. Signature: ________________________________________________________ (must be signed to participate) Cash: ______ Cheque: _____ # __________ Rider Band # ___________________________ RIDER REGISTRATION / RELEASE FORM If you would like to make a donation to the Children’s Wish Foundation (DIG DEEP… IT’S FOR THE KIDS!!), please do so with a separate cheque and submit it with the attached donation form. CANADIAN OILFIELD RIDERS ASSOCIATION – 27th ANNIVERSARY Run for The Children’s Wish Foundation SATURDAY, June 20TH, 2015 ENTRY FEE: $75.00 FOR PRE-REGISTRATION (before May 30th to receive 27th Anniversary Preregistration Gift) $75.00 IF YOU REGISTER AFTER May 30th (or on the day of the event) You do not have to ride to participate in this event, however because this is a fundraising event, You MUST register to participate. For Pre-registration on line: www.canadianoilfieldriders.ca (PayPal available) or you may fill in the form below & mail to: Canadian Oilfield Riders Association 5677 Burleigh Crescent SE Calgary, Alberta T2H 1Z7 Phone: (403) 255-3730 A separate registration form must be filled out and a separate fee for both rider and passenger -- PLEASE PRINT CLEARLY – NAME: __________________________________________________ DATE:_____________________________ ADDRESS: ______________________________________________ CITY: ______________________________ PROV / STATE:___________________________________ POSTAL / ZIP CODE: ______________________ HOME PHONE: _________________________________ BUS PHONE: _____________________________ Email Address: _____________________________________________________________________________________ EMERGENCY CONTACT: ________________________________ PHONE: ___________________________ I hereby represent and certify that I am over the legal age of 18 years and the information I have given is true and correct. I recognize and understand that the Canadian Oilfield Riders, and the Children’s Wish Foundation of Alberta and the Co-Sponsors or their representatives (all being collectively referred to hereafter as “released parties”) are relying upon the accuracy of the information I am providing in allowing myself to participate in the above listed charity ride. I hereby state that I am experienced in and familiar with the operation of motorcycles and fully understand the risks and dangers inherent in motorcycling. I am voluntarily participating in the charity ride and I expressly agree to assume the entire risk of any accident or personal injury, including death that I might suffer as a result of my participation in the charity ride. I participate in the ride knowing the existing weather conditions, road conditions and other similar conditions and factors associated with this ride could be hazardous. For and in consideration for the opportunity to engage in the ride for charity, I (on my own behalf and on behalf of my heirs, personal representatives, successors and assigns) do hereby release and forever discharge the released parties (including their officers, directors, employees, agents and insurers) from any and all claims, demands, rights and causes of actions of any kind whatsoever which I now have, or later may have, known or unknown, in any way resulting from or arising out of, my participation in this ride. This release extends to any and all claims that I have or may have against the released parties whether such claims result from strict liability or negligence on the part of any of all of the released parties with respect to the design, manufacture, repair or maintenance of the motorcycle(s) which I will be riding during the charity ride, or with respect to the conditions, qualifications, instructions, rules or procedures under which the ride is conducted or from any other cause. However, I do not release any released party from any intentional misconduct on their part. BY SIGNING THIS RELEASE, I CERTIFY THAT I HAVE READ THIS RELEASE AND FULLY UNDERSTAND IT, AND THAT I AM NOT RELYING ON ANY STATEMENTS OR REPRESENTATIVES OF ANYONE RELEASED THEREBY. I have made my CHEQUE PAYABLE TO “CANADIAN OILFIELD RIDERS ASSOCIATION”. I will conform to all rules and regulations of the Canadian Oilfield Riders Charity Run. I WILL NOT OPERATE A MOTOR VEHICLE WHILE UNDER THE INFLUENCE OF ALCOHOL OR ANY OTHER ILLEGAL DRUG OR CONTROLLED SUBSTANCE. Signature: ________________________________________________________ (must be signed to participate) Cash: ______ Cheque: _____ # __________ Rider Band # ___________________________ CHARITABLE DONATION FORM You should fill this form out ONLY if you wish to make a donation to the Children’s Wish Foundation. Entry for Participation in this event must be done separately by filling our the attached Rider Registration / Release From, CANADIAN OILFIELD RIDERS ASSOCIATION – 27th ANNIVERSARY Run for The Children’s Wish Foundation Weekend of June 20th, 2015 Proceeds raised from this event will be donated to the CHILDREN’S WISH FOUNDATION OF ALBERTA Please ensure that all donations are made payable to the “Children’s Wish Foundation of Alberta”. A tax deductible receipt will be forwarded to all donors by the Children’s Wish Foundation of Alberta. Attach your donation to this form and return both to a Canadian Oilfield Riders Association Committee representative or mail to: Children’s Wish Foundation of Alberta C/o Canadian Oilfield Riders Association 5677 Burleigh Crescent SE Calgary, Alberta T2H 1Z7 Attention: Larry Pedersen (255-3730) LEVEL OF DONATION YOU ARE MAKING (PLEASE CHECK THE APPROPRIATE BOX) Roughneck - $50.00 Motorman - $100.00 Derrickman - $250.00 Driller - $500.00 Toolpush – over $500.00 -- PLEASE PRINT CLEARLY – Send my tax receipt for $______________ NAME: _________________________________________ ADDRESS: ______________________________________________ CITY: ______________________________ PROV / STATE: ___________________________________ POSTAL / ZIP CODE: _______________________ Email: ___________________________________________ HOME PHONE: _________________________________ SIGNATURE: ___________________________________ BUS PHONE: _____________________________
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