Coast 2 Coast 2018 Registration March 2 April 23, 2018

Transcription

1 Coast 2 Coast 2018 Registration March 2 April 23, 2018 Please Type or Print Clearly Name Male Female Address: City, State & Zip: Birth Date / / Age Address: Home Phone: ( ) Cell Phone: ( ) How did you hear about this tour? Internet Search Word of Mouth/Friend Magazine Ad Shirt Size: Bike Jersey Size (Bike Jersey s run small): Emergency Contact Name: Relationship: Address: City, State, Zip: Cell Phone: Home Phone: Vegetarian? Yes Heck no, I want to enjoy some of that good Texas Brisket Please note. If you have dietary requirements other than vegetarian you must discuss them with our chef in advance of registering. Anne can be reached directly at info@culinaryinsdier.com Medical Conditions Do you have any medical conditions you wish to share and make Bubba aware of? This information will be held in the strictest of confidence and not shared. If so, please explain here. As a reminder; before registering you must call Bubba directly ( ) to assure this is the correct tour for you.

2 Additional Forms Additional forms below must be signed and sent in with the registration forms in order for your registration to be processed. These forms are legal documents with legal consequences and need to be read and understood fully before signing. Payment schedule 50% of the registration fee must be sent at time of registration. The balance must be received by January 1, 2018 or your registration will be forfeited and the cancellation policy enforced. Cancellation Policy Please read carefully and fully understand before sending in your payment. This cancellation policy will be strictly adhered to. Please, DO NOT ask for exceptions to this cancellation policy, none can/will be granted. There will be a $1000 cancellation fee applied if cancellation is received before October 1, 2017 There will be a $1500 cancellation fee applied if cancellation is received before November 1, 2017 There will be a $2000 cancellation fee applied if cancellation is received before December 1, 2017 There will be a $2500 cancellation fee applied if cancellation is received before January 1, 2018 Trip Insurance Trip insurance is highly suggested and available from many sources. Please review cancellation policy once again while deciding if you wish trip insurance. Once source for trip insurance is Mc Kay Insurance Registration Fee Registration Fee Single in Regular Tent One Twin Mattress $9400 Single in Bubba Dome: One Twin Mattress $9600 Double in Bubba Dome: One Queen Two Twins $9400 per person Double Rate applies to each rider sharing the same tent The Bubba Dome is a very large tent which allows you the ability to stand and move about. A very popular upgrade. Staff Appreciation (Gratuity) of between 15% and 18% per rider is suggested. These funds will be divided equally among all staff. If you wish, you can be added at the time of registration. If not, it will be collected towards the end of the event. Yes, I would like to add the gratuity in advance in the amount of $ Total Fee: $ Minus 50% Deposit: $ Balance: $ Make check payable to Bubba Barron and mail to: Bubba Barron P.O. Box Tampa, FL Signature Print Full Name Date

3 Coast 2 Coast Waiver and Release Please read this carefully. This is a contract with legal consequences. I, the undersigned, know that Coast 2 Coast is a potentially hazardous event, and attend it out of my own free will and choice. In choosing to attend Coast 2 Coast and any related events or activities, I fully accept and assume all risks, whether before, during or after Coast 2 Coast and/or related events or activities. These include, without limitation, risk of physical injury mental injury, mental stress, emotional stress, trauma, death, contact with other participants, equipment failure, inadequate safety equipment, effects of weather including extreme temperature or conditions, traffic, contact with motor vehicles of all types and descriptions, collision with other riders or fixed or moving objects, the conditions of the roads, theft, damage or theft to vehicle whether on event or parked at long term parking area, camping and participating in events or activities along the route. All risks are known, understood, and appreciated by me. I waive any and all specific notice of the existence of risks. I agree that leaders and maps are provided for my convenience only and do not guaranty a safe route or trip. I shall assume and pay my medical and emergency expenses in the event of injury, illness or other incapacity regardless of whether I authorized such expense. I realize Coast 2 Coast requires physical conditioning and I represent that I am in sound medical condition capable of participating in the ride without risk to myself or others. I have no medical impediment that would endanger myself or others. I understand that situations may arise during Coast 2 Coast that may be beyond the control of sponsors, promoters and organizers. I will be solely responsible for the condition and adequacy of my bicycle, safety gear and riding equipment. I will ride safely within the limits of my own abilities, my equipment and the riding conditions and in a manner so as not to endanger myself or others. Knowing these facts and in consideration of my entry, acceptance, admission an to and participation in Coast 2 Coast and its related events and activities, I, for myself and anyone acting on my behalf, waive, release, discharge, indemnify, covenant not to sue and agree to hold Coast 2 Coast, the staff of Coast 2 Coast, Bubba s Pampered Perales LLC, the staff of Bubba s Pampered Pedalers LLC, any and all sponsors, communities, cities, towns, counties, and states, organizations, Coast 2 Coast, Bubba s Pampered Pedalers employees-representatives-volunteersagents-insurers-insurance brokers and successors of all above, harmless from any and all claims, demands and actions of any and every kind that I have, may have or may hereafter accrue against the released parties, directly or indirectly, arising out of or relating in any respect to my attendance or participation in Coast 2 Coast and its related events and activities, including, without limitation, litigation expenses, attorney fees, loss liability, damages or cost. My waiver and release of all claims, demands, actions and liability shall include, without limitation, any injury, damage or loss to my person or property which may be caused by any act, or failure to act, by the above identified persons and entities or sustained by me before, during or after Coast 2 Coast and its related events and activities. I agree to abide by all Coast 2 Coast rules and regulation. I waive my rights of privacy or publicity and grant permission to all of the forgoing to use any photographs, motion pictures, videotapes, recordings or other record of this event for any legitimate purpose. I further agree to indemnify and hold the parties released above harmless from any and all losses, damages, claims and expenses, including attorney fees, arising from or relating in any respect to my participation in Coast 2 Coast or its related events and activities. If I am a minor, my parent or guardian is also signing on my behalf and we both agree to be bound by the same terms of this agreement, waiver and release. If I am the parent or legal guardian of a minor child participant, I certify that the minor is in good health, qualified and in proper physical condition to participate in Coast 2 Coast and I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless all of the above released parties from all liability, claims, demands, losses or damages on the minor s account incurred in connection with Bubba Fest--Coast to Coast or its related events and activities. I will indemnify, save and hold harmless each of the released parties from any litigation, expenses, attorney fees, loss liability, damage or cost that may occur as the result of any such claims in connection with the minor s participation in Coast 2 Coast and its related events and activities. Signature (signature of parent or guardian if under 17 years of age) Waiver must be signed and dated in order to attend this event Print Full Name Date

4 Cancellation Policy Coast 2 Coast Tour Please read carefully and fully understand before sending in your payment. This cancellation policy must and will be strictly adhered to. Please, DO NOT ask for exceptions to this cancellation policy, none can/will be granted. There will be a $1000 cancellation fee applied if cancellation is received before October 1, 2017 There will be a $1500 cancellation fee applied if cancellation is received before November 1, 2017 There will be a $2000 cancellation fee applied if cancellation is received before December 1, 2017 There will be a $2500 cancellation fee applied if cancellation is received before January 1, 2018 Do to contractual obligations, no refunds (for ANY REASONS) can be offered January 1, 2018; including once the Coast 2 Coast Tour has started. Trip Insurance Trip insurance is highly suggested and available from many sources. Please review cancellation policy once again while deciding if trip insurance is an option you should consider. One source for trip insurance is: McKay Insurance Again, this tour cannot stress enough; the stated cancellation policy will and must be strictly adhered to. NO EXCEPTIONS can/will be allowed for ANY REASON. If you must cancel, the tour will be more than happy to assist you in filing a claim with your trip insurance company. I am fully aware of the stated cancellation policy and understand stated cancellation policy will and must be strictly enforced. I also understand trip insurance is available from various sources and if for any reason I must cancel, I understand the tour will assist in filling a claim with said insurance company. Printed Name: Signature:

5 Coast 2 Coast I understand and agree to the following: I understand this is a Cross Country Bicycling Adventure Tour I understand my physical conditioning must be at a level to complete this tour I understand I will be expected to ride my bicycle the entire route every day except rest days I understand I will be riding my bicycle in all types of weather including but not limited to rain, cold, heat and wind I understand the road types will vary including but not limited to; two lane country roads, two and four lane urban roads, four lane highways, and inter-state highways, with some of the roads having no shoulders I understand road conditions will vary and fully understand all roads will not be smooth riding including but not limited to; Chip and Seal Roads needing repair Roads with debris I understand I will be bicycling in all sorts of areas including but not limited to; remote, rural, semiurban, and urban. I understand I will be bicycling in all types of traffic situations with all types of motor vehicles sharing the same roads I understand and accept the risk factor of sharing the same road ways with all types of motor vehicles I understand there must be a blinking red light showing from the rear of my bicycle and a white light facing forward from the front of my bike which must be activated at all times while riding I understand I must wear a safety green vest (mesh) at all times while riding. (provided by tour) I understand I will be riding distances of up to 95 miles at times, with limited or no facilities other that SAG vehicles I understand there will be either SAG Stops with drinks snacks limited food provided by the tour as well as SAG Check-Ins which are local businesses along the way.. I understand the tour supports the local businesses by not having a SAG Stop on their property but instead SAG Check-In. I understand the riders are encouraged to purchase items from the local businesses as a means of thank you for the use of the rest room and water bottle fill-up while expressing good-will I understand the average daily mileage of this tour is 65. I understand the mileage on the route sheets may not exactly match what is on my cycle computer. I understand if I wish to optimize internet service I should bring a devise with a hot-spot. I also understand, at times, even with a hot spot internet service may not be available I understand at times there will be very limited or no cell phone coverage I understand I must be totally self-sufficient while riding my bicycle including changing of flat tires I understand and agree to have enough water with me to complete 30 miles of riding

6 I understand dietary needs other than vegetarian must be discussed in advance with the tour chef and depending of those needs there may be additional fees associated I understand if I get separated/lost at any time, I will use resources available in finding my way to the overnight town on my own I understand this bicycle tour will move every day except rest days and, if for any reason, I am unable to move forward it will be totally my responsibility to rejoin the group I understand this is primarily a tent camping tour with some hotel/motel stays as well as other indoor group sleeping where I will be sleeping in a large room with the other riders. I understand and agree to stay nightly where the group is staying, I understand there will be no transportation available to other nightly options. I understand the over-night facilities will vary greatly. I understand this tour selects the best option available. Some over -night locations being better than others. Some having very limited accommodations. At times the group will be sharing one bathroom and one shower. I understand those times with limited facilities; I may have to wait in a line to shower or use the restroom. I also understand at times the hot water may have been used up and I may have to wait for the hot water heater to recycle if I wish a hot/warm shower. I understand this is a group activity and will I be spending most of my time with the same people on this tour I understand when the tour stays in hotels I will be sharing a room with a fellow rider of the same gender I understand by participating in this group activity, decisions will be made for the good of the group as a whole I understand there will be an agenda (schedule) which, for the good of the group, will be followed I understand meal and SAG hours/times will be strictly enforced. I also understand I will arrange my daily schedule to fit those times and if not, it will be my responsibility to find meals and/or SAG needs along the way. I understand getting myself and gear to the starting point and home from the ending point is totally my responsibility I understand and agree to the stated cancellation policy and understand it will be fully enforced. I understand, as part of the cancellation policy, no refunds will be offered for any reasons, after January 1. I understand trip insurance can be purchased at my expense which would cover registration fees in the event I must have to cancel before the event starts or abort once the event starts. I understand I must call Bubba and discuss this tour before registering Signature Print Full Name

7 Coast 2 Coast Safety Promise While riding on the Coast 2 Coast Tour, I promise at all times to: Wear my bicycle helmet while riding my bicycle Wear bright clothing making myself more visible Wear a safety green vest at all times while riding Equip my bicycle with a rear blinking light and a white blinking front light and have both lights blinking while riding Use standard hand signals announcing turns Not wear any type of headphones while riding my bicycle Not to talk on cell phone or text while riding my bicycle Obey all traffic laws, signs and signals Ride defensively always being aware of other riders, vehicles, and pedestrians around me, never assuming what they are doing or what they are about to do. Call out car up/car back to riders around me Point out road hazards and yell Gravel Hole Glass etc. to riders around me Call out my intentions to riders; Slowing Stopping Turning Ride in single file when a motor vehicle is behind me Never ride more than two abreast and never be a road hog thus allowing motor vehicles and other bicyclists plenty of room to safely pass Always ride as far to the right as safely possible Use common sense and be courteous towards motorists and other bicyclists Never to ride before daylight or after dusk. If stopping for any reason, I will move completely off the roadway Call out On your left while passing a slower rider and never pass on the right. I understand and fully accept I can and may be removed from this Coast 2 Coast Tour, without refund, if I do not obey these safety rules. To be a smart, safe, and savvy bicyclist Printed Name Signature Date

8 Medical information Coast 2 Coast Please complete this form, place the form into a sealed envelope, print your name on the outside of the envelope, and mail with registration. The envelope will remain sealed unless there is an emergency. Name: Address: City: State: Zip Code: Home Telephone: Birth Date: Gender Religious Preference: In Case of Emergency Please Notify Name: Address City: State: Zip Code Home Phone: Cell Phone: Living Will: Yes No Donor: Yes No Power of Attorney for Health Care: Yes No Name of that person: Phone Number of that person: Insurance Information Company Name: Policy Number: Telephone: Medicare number: Primary Physician name: Telephone: I am taking the following medications Drug Name Strength Dosage How Often For Repeat if needed Signature: Date:

9 Coast 2 Coast Tour Computer---Lap Top Other Fragile Items The ride will do all in its power to assure the safe daily transportation of the above mentioned items. That said, with load shifts in the support vehicles damage to these items is possible. I understand in order to maximize the protection of these and like items I will store them in a damage proof container which I, the rider, will provide. I also agree to hold harmless the Coast 2 Coast Tour and its staff for any damage which might occur to these and like items. Printed Name: Signed Name: