Read, sign, and send the below waiver and mail with a $55 per person registration fee. We accept checks, money orders, and credit cards. If paying by credit card, please be sure to fill in all the appropriate information.
You will pick up your registration packet at the rally.

Registration Form

Name/s: ________________________________________________________________
Address: ________________________________________________________________
              ________________________________________________________________

Telephone # _______________________________________________________

Today's Date: _______/________/________

Credit Card: VISA / MasterCard / Discover / American Express
Card Number: ______________________________
Expiration Date: _______/________/_________

Signature: ____________________________________

$55 fee includes participation in the Saturday and Sunday rides, door prizes, and Saturday evening meal and party.

Rally t-Shirts are $12 each. If you want
one please order early, as we are printing a limited number this year.

Indicate T-Shirt Size: Small / Medium / Large / X-Large / Other ____

I understand that there are inherent and other risks of injury or death involved in the sport of bicycling, that injuries are a common and ordinary occurrence of this sport and that death may occur. I FREELY ASSUME ALL SUCH RISKS of injury or death including but not limited to those presented by the layout of the route or the activity, to all conditions of the routes, bicycles, and tricycle; vehicular and and other traffic; fellow participant's actions; first aid; and weather conditions. By participating in the RBR Recumbent Rally, I, personally, and on behalf of my heirs, personal representatives, successors and assigns, specifically agree to assume any and all risks of injury and death which may be associated with my participation in the RBR Recumbent Rally. I, personally, and on behalf of my heirs, personal representatives, successors and assigns, hereby release, waive, discharge and covenant not to sue all organizers, promoters, sponsors, participants and all other persons and associations connected with the RBR Recumbent Rally including but not limited to Recumbent BikeRiders, Inc., and all of their officers, directors, agents, employees, predecessors, successors and assigns (hereinafter referred to as the released parties) for any and all injuries or damages of any kind whatsoever including death suffered by me as a result of my participation in the RBR Recumbent Rally including but not limited to injuries, damages and/or death caused by the negligence of the released parties. I hereby acknowledge that RBR - Recumbent BikeRiders has advised me and/or my children to wear an ANSI or Snell approved helmet. I understand that there are additional risks of injury or death involved in riding without a helmet, and if I refuse to wear an appropriate helmet, I freely assume all those additional risks. I have read and I voluntarily sign this AGREEMENT and I understand that by signing it I, personally, and on the behalf of all my heirs, personal representatives, successors and assigns, am giving up all rights that I might otherwise have to make claims against the released parties for their negligence in causing injury or death sustained by me as a result of my participation in the RBR Recumbent Rally.

Signed: __________________________________________________________

Date:_______/________/_________

RBR - Recumbent BikeRiders, Inc.
1306 S. Atherton St.
State College, PA 16801
Toll Free USA: (888) 875-2508
Local/Intl/Fax: (814) 234-4636 (234-INFO)
HOURS: 10-6 Tues, Wed, Fri, Sat; 1-6 Thurs; Mon and Sun by appointment
E-Mail: sales@rbr.info
Web Site: http://rbr.info

© 2005 RBR Inc. All rights reserved.