Entry Form

Please print this form

Yes I want to participate in the 2000 Paris to Ancaster / Tour of Ancaster epic ride. I am prepared to accept the challenge and have read, understood and signed the release form. Mountain bikes, hybrids, or cyclocross bikes are recommended.

___Paris to Ancaster 60km $35 (includes t-shirt if received before April 5)

___Tour of Ancaster 15km $15 ($10 for age 12 and under)

Name______________________________________Age_________Sex________

Club________________________ (Ontario Cycling Association affiliate or equivalent)

OCA/CCA membership# ___________________

Address___________________________________________________________

City__________________________ Province/State______________

Postal Code_________

Telephone_______________________

Email ___________________________

___No, I don't need a ride. I have made my own arrangements to be picked up in Ancaster after the ride.

___Yes, I will need a ride to the start line. I will meet the bus at the Ancaster Community centre at 8:30am sharp on April 9. I have enclosed $5 to cover the cost.

___Yes, I will need a ride back to Paris after the finish. I have enclosed $5 to cover the cost.

Please make cheques payable to:The Special Event Company.
Mail to: 1064 Westhaven Dr.
Burlington, Ontario
L7P 5B5
or drop it off at our sponsoring store locations:Pieriks Cycle
840 King Street West
Hamilton

Ziggys Cycle
2290 King Street E
Kitchener


For more information email specevent@idirect.ca or call 905-829-4251

Waiver

In consideration of the acceptance of this entry, I intend to be legally responsible for myself, my heirs, administrators, executors and do hereby discharge and release the organizing committee of the Paris to Ancaster Race and Tour and the Tour of Ancaster, The Special Events Company, Cycle Hamilton, The Ontario Cycling Association, and any and/or all sponsors and their representatives, assigns and successors from any and all liability arising from injuries, illness, and damages that I may suffer as a result of my participation in this event or transportation to and from the event venues. I further attest that my physical condition has been verified in the past twelve months by a medical doctor and I consent to medical treatment. I also release my permission for the free use of my name and / or picture in any broadcast, telecast or other account of this event. On public highway sections of this race and tour I agree to abide by the Ontario Highway Traffic Act and to follow the instructions of the race marshals and police officers.

Signature of participant:_____________________________________________


Signature of Parent or Guardian:_______________________________________
(if participant is under 18 years of age)


Date:_________________