Nickname to use on biclcyle tag.    First name will be used if left blank

Leave blank if payment will be submitted using the name above. If payment via either check or credit card will be made by someone else please provide the name of that person who will be making payment here so we can track payments. A separate Registration Questionnaire must be submitted for each rider:

City    State    ZIP

E-mail (to confirm your registration)  

Confirm you E-mail (must match)       

Telephone w/area code: Daytime         Evening   

 I would like to be able to check my registration status online, so you may show my name, city, state, and registration status on the website (Others will see it too),

 I would like to be included in a roster listing name, address and email distributed after the tour to all guests (will not be posted online)

Emergency contact #1 (not riding tour)

(Please enter available phone numbers below / that are most likely to result in a timely successful contact in case of emergency)

Relationship Phone Day   Phone Eve   Phone Cell  

Emergency contact #2 (not riding tour)

Relationship Phone Day   Phone Eve   Phone Cell  

Medical insurance provider

Emergency contact riding tour, if any:   

Bicycle type: single  recumbent tandem   Name of tandem partner:

The Tour will transport your bike by truck from San Jose to Bear Valley and back to San Jose from San Francisco. If you need this service, please indicate how you plan to protect your bike during shipment.  Since bike cases do not fold flat, transporting these incurs an extra fee.

Cardboard bike box

Soft bike bag (collapses for storage)

Bicycle case, either hard or soft sided ($25 storage fee required). 

Will not need this service because I am bicycling or driving.  Please specify: Please Select Will be on ACTC Club Ride to Start I will arrange bike transportation myself

Will you need a seat on the charter buses? 

I wish to reserve the bus from San Jose to Bear Valley (6/17/06) $30 fee Yes No

I wish to reserve the bus from San Francisco to San Jose (6/24/06) $15 fee Yes No

(If you reserve a seat on the bus, and later find that you won't need it, please notify the Registration Coordinator as soon as possible)

Each rider will receive a commemorative cycling jersey.  Please specify type and size:

Male or Female Style: Select Style Male Female    Jersey Size:  Please Select Small Medium Large Extra-Large Extra-Extra Large

ACTC member            Previous participant          ACTC website   Sierra to the Sea website

Friend who did SttS (name)  

Another club (please specify name & state) 

Publication (please specify) 

Other

Please read the waiver carefully: (version for printing)

. By checking the box below, you agree, warrant and covenant as follows: League of American Bicyclists (LAB) Release and Waiver of Liability, Assumption of Risk, and indemnity Agreement IN CONSIDERATION of being permitted to participate in any way in this Almaden Cycle Touring Club (“Club”) sponsored Bicycling Activity (“Activity”), I for myself, my personal representative, assigns, heirs, and next of kin: 1.  ACKNOWLEDGE, agree and represent that I understand the nature of bicycling activities and that I am qualified, in good health, and in proper physical condition to participate in such Activities. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further acknowledge that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITES INVOLVE RISK AND DANGERS OF SERIOUS BODILY INJURY,INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“RISKS”); (b) these risks and dangers may be caused by my own actions, or inactions, the actions of others participating in Activity, the conditions in which Activity takes place, or THE NEGLIGENCE OF THE “RELEASEE” NAMED BELOW; (c) THERE MAY BE OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time, and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation in the Activity. 3. HEREBY RELEASE, DISCHARGE, CONVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Club, the LAB, their respective administrators, directors, agents, officers, employees and volunteers, other participants, any sponsors, advertisers, and, if applicable, owners and leasers of the premises on which the Activity takes place (each considered one of the “RELEASEES” herein), FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERS, INCLUDING NEGLIGENT RESCUE OPERATIONS. I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, losses, liability, damages, or costs which any may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILTY TO THE GREATEST EXTENT ALLOWED BY LAW. I AGREE THAT IF ANY PORTION OF THE AGREEMENT IS HELD INVALID, THE BALANCE, NOT WITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. .

I agree with the above waiver NOT Agree Agree