NATIONAL CAPITAL BICYCLE TOURS REGISTRATION & RELEASE AGREEMENT Submit a separate form for each rider. This form may be duplicated. A separate Release Agreement (below) must be signed and returned for each adult rider. For riders under age 18, the Parental Consent Agreement (below) must be completed instead. The National Capital Bicycle Tour takes place October 4, 1998 rain or shine. All tour fees are non-refundable. ____________________________________________________________________________ Last Name (print or type) ____________________________________________________________________________ First Name ____________________________________________________________________________ Address ____________________________________________________________________________ City State Zip ____________________________________________________________________________ Home Phone Work Phone Please circle your intended tour. (You can change your mind on the day of the ride.) ( ) Capital City Tour: 32 miles ( ) Capital Crescent Tour: 9 or 23 miles ( ) Capital Countryside Tour: 42 50 62 80 or 100 miles Contact in case of emergency: ____________________________________________________________________________ Name Phone Will this person be with you on the ride?___________________________________ Registrations postmarked or faxed no later than September 14 will receive a free T-shirt (to be distributed at the ride). T-Shirt Adult Sizes: ( ) S ( ) M ( ) L ( ) XL Fees: Current WABA Member ........................................$20 Team Participant ...........................................$20 Name of Team: ____________________________________________ Non-WABA Member ............................................$25 Tour with Special WABA Membership ..........................$40 Student (no T-shirt) .......................................$15 Children Aged 6-12 (no T-shirt, must ride with an adult) ...................................$10 T-Shirt (if registering after Sept. 14) ....................$10 Total: ________ Method of Payment: ( ) Visa or MasterCard ( ) Check Fax credit card registrations to WABA at 202-833-4626. ____________________________________________________________________________ Card Number Exp. Date ____________________________________________________________________________ Signature ____________________________________________________________________________ Print Name Make checks payable to and mail to: Phone: 202-628-2500 Washington Area Bicyclist Association FAX: 202-628-4141 733 15th Street, NW, #1030 E-mail: waba@waba.org Washington, DC 20005 Website: www.waba.org