Register // 2010 Cycling for Sight Registration Form

Register Form Use the form below to register for the 2010 Cycling for Sight Tour. If you have any technical issues, please contact Audrey Walz, (619) 583-1542.

Carefully & completely fill out this form or you will have to restart & re-enter the registration data. Thank you.

*required items

Category Information

There are five category options to choose from. Please review the descriptions to the right.

* Category

Personal Information * First Name
* Last Name
* Email
* Phone

nnn-nnn-nnnn

* Gender

Address * Street Address
Apt/Suite
* City
* State
* Zip

Emergency Information * Emergency Contact
* Emergency Phone

nnn-nnn-nnnn

Clothing * T-Shirt Size

Agreements

Please read any waiver carefully. It includes a release of liability and waiver of legal rights and deprives you of the ability to sue certain parties. Do not agree to this document unless you have read and understood it in its entirety. By agreeing electronically, you acknowledge that you have both read and understood the text presented to you as part of the registration process. You also understand and agree that events carry certain inherent dangers and risks which may or may not be readily foreseeable, including without limitation personal injury, property damage or death. Your ability to participate in the event(s) is/are subject to your agreement to the waiver and by agreeing herein, you accept and agree to the terms of the waiver and release agreement.

PARTICIPANT AND VOLUNTEER ACCIDENT WAIVER AND RELEASE OF LIABILITY
I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating 81or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: All governmental entities; including BUT NOT LIMITED TO: San Diego Center for the Blind, Blind Stokers Club, UC Irvine and Pfizer Inc.: their respective directors, officers, employees, volunteers, representatives, and agents, the event owners, event sponsors, event directors, event volunteers, and co- participants; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entitles as a result of any of my actions during this event.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and or illness during this event.

I understand that at this event or related activities, I may be photographed, videoed, filmed or otherwise have my likeness, voice or a combinational recorded. I agree to allow my photo, video or film or sound likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and/or assigns.

This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

You must be over 18 years of age OR the parent/legal guardian of a minor under 18 years of age OR the legal guardian of an incapacitated and/or mentally challenged person in order to agree to the text above.

I hereby certify that I have read this document, I understand its content and I agree.

* Date of Birth:	/	/
	MONTH (MM)	DAY (DD)	YEAR (YYYY)

* Initials:
Guardian Full Name:

If you are a minor, we need the full name of your parent / guardian.

Registration Information Registration Amount (minimum is $50)

DO NOT USE DOLLAR SIGN. ONLY DOLLAR VALUE. Example: Enter 50 for $50.

Payment Method

To complete registration, click the Send button. DO NOT CLICK the Send button unless the form has been filled out completely or you will have to refill in Category and Waiver information.

By clicking the Send button, you agree to the Privacy Policy.

Participation Categories

Tour of Vision (3 Day Tour)
Participants receive all benefits and options. Each participant on a single bike agrees to and is required to contribute a minimum of $1200,   Each participant on a tandem agrees to and is required to contribute a minimum of $900 ($1800 per tandem). A deposit of $50 is required at the time of registration.

BSC Tandem Teams (local or distant) have a goal of raising $1800.

Full payment of the required minimum fundraising amount is due by July 29th in order to participate.

Roll-Out (First Day Only Participant) - no lodging or meals, $250
This category includes riders who would like to join us on only the first day of our tour. You may join us for on Day 1 beginning at Pfizer La Jolla. Goodie bag includes CFS Jersey and T-shirt.

Cyclo-Rallye (Second Day Only Participant) - no lodging or meals, $250
This category includes riders who would like to join us on only one the second day of our.   You may join us in Irvine. Goodie bag includes CFS Jersey and T-shirt.

Arrivêe (Third Day Only Participant) - lunch and Finish Line Fair included, $250
This category includes riders who would like to join us on only on the third day of our tour. You may join us for Day 3 in Irvine or at Magee Park in Carlsbad. Goodie bag includes CFS Jersey and T-shirt

Volunteer or Staff
A limited number of volunteer positions are available. Applying in this category does not guarantee acceptance. Volunteers and Staff are complimentary guests of the tour.

Cycling for Sight Directors

To contact a person below, please click on their name.


David Shalinsky CFS Event Director	Dave White Blind Stokers Club

Donations

Benefits the San Diego Center for the Blind & the Blind Stokers Club.
100% of your donation is tax-deductible.

Contact Information

San Diego Center for the Blind
5922 El Cajon Boulevard
San Diego, CA 92115-3826
(619) 583-1542
www.cyclingforsight.org
To Email: Please use Contact Form