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Stuart Rich
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1 Option A Bubba s PAMPERED Pedalers Charter Registration RAGBRAI 2018 Service starts at ending town and includes transportation to starting town Please Type in Information Name: Male : Female: Address: Age Birth Date / / City, State & Zip: Home Phone: Address: Cell Phone: Shirt Size: Extra Small: Small: Medium: Large: XL: 2XL 3XL: Emergency Contact Name: Home Phone: Address: Cell Phone: City, State, Zip: Relationship to you: Medical Conditions Do you have any medical conditions you wish to share and make Bubba aware of? If so, please explain. I will be riding: Up-Right: Tandem: Recumbent: Trike: Fees which covers everything mentioned in information letter Single in Regular Tent with One Twin Mattress: $725 Single in Bubba Dome with One Twin Mattress: $799 Double in Regular Tent with One Queen Size Mattress: $620 per rider Double in Bubba Dome (please select) Two Twin Queen Mattress $670 per rider If registering as a double occupancy, both registrations must be mailed together. The Bubba Dome is really large tent which allows you to stand and move about. A very popular upgrade. Total Fee: Registration fee must be paid in full at time of registration Make check payable and send to: Please remember to use Sunscreen. Melanoma KILLS Bubba Barron PO Box Tampa, FL Cancellation Policy: Bubba understands things happen which are out of your control. If you cancel on or before May 20 you will receive a full refund minus a $300 cancellation fee. Sorry, due to contractual obligations no refund will be offered for ANY REASON after May 20. Trip insurance is available through various carriers. Please do not ask after May 20, 2018, it just cannot happen. If you do not get a confirmation within two weeks of registering, please GraceForBPP@yahoo.com to make sure your registration form was received. Print Name: Signature: Registration must be accompanied with a signed waiver form in order to be accepted

2 Option B Bubba s PAMPERED Pedalers Charter Registration RAGBRAI 2018 Please Type in Information For riders starting RAGBRAI at the starting town and not needing transportation. Name: Male: Female: Address: Age Birth Date / / City, State & Zip: Home Phone: Address: Cell Phone: Shirt Size: Extra Small: Small: Medium: Large: XL: 2XL 3XL: Emergency Contact Name: Home Phone: Address:: Cell Phone: City, State, Zip:: Relationship to you: Medical Conditions Do you have any medical conditions you wish to share and make Bubba aware of? If so, please explain. Fees which covers everything mentioned in information letter except transportation to the start Single in Regular Tent with One Twin Mattress: $675 Single in Bubba Dome with One Twin Mattress: $750 Double in Regular Tent with One Queen Size Mattress: $570 per rider Double in Bubba Dome (please select) Two Twins Queen Mattress $625 per rider If registering as a double occupancy, both registrations must be mailed together. The Bubba Dome is a really large tent which allows you to stand and move about. A very popular upgrade. Total Fee: Registration fee must be paid in full at time of registration Make check payable and send to Bubba Barron PO Box Tampa, FL Cancellation Policy: Bubba understands things happen which are out of your control. If you cancel on or before May 20 you will receive a full refund minus a $300 cancellation fee. Sorry, due to contractual obligations no refund will be offered for ANY REASON after May 20. Trip insurance is available through various carriers. Please do not ask after May 20, 2018; it just cannot happen. If you do not get a confirmation within two weeks of registering, please GraceForBPP@Yohoo.com to make sure your registration form was received. Print Name: Signature: Registration must be accompanied with a signed waiver form in order to be accepted Bubba s PAMPERED Pedalers Charter Waiver and Release

3 Option C Bubba s PAMPERED Pedalers Charter Registration RAGBRAI 2018 Please Type in Information For riders who want to bring their own tent however want all the rest of the PAMPERING Service included with this charter Name: Male: Female: Address: Age Birth Date / / City, State & Zip: Home Phone: Address: Cell Phone: I will be riding: Up-Right: Tandem: Recumbent: Trike: Shirt Size: Extra Small: Small: Medium: Large: XL: 2XL 3XL: Emergency Contact Name: Home Phone: Address:: Cell Phone: City, State, Zip:: Relationship to you: Medical Conditions Do you have any medical conditions you wish to share and make Bubba aware of? If so, please explain. -+++Fees which covers everything mentioned in Option A with the exception of tent and air mattress. That s right, you bring your own tent and set it up and take it down however you can still enjoy all the rest of the PAMPERING. Towels. Chair. Electronic Charging Station. Cold Drinks. Snacks. You get the idea, everything all the others are getting except the tent. Total Fee: $550 for one $790 for two sharing the same tent. Registration fee must be paid in full at time of registration Make check payable and send to Bubba Barron PO Box Tampa, FL Cancellation Policy: Bubba understands things happen which are out of your control. If you cancel on or before May 20, you will receive a full refund minus a $300 cancellation fee. Sorry, due to contractual obligations no refund will be offered for ANY REASON after May 20. Trip insurance is available through various carriers. Please do not ask after May 20, 2018; it just cannot happen. If you do not get a confirmation within two weeks of registering, please GraceForBPP@Yohoo.com to make sure your registration form was received. Print Name: Signature: Registration must be accompanied with a signed waiver form in order to be accepted

4 This waiver is a contract with legal consequences. Please read carefully. I, the undersigned, know that Bubba s PAMPERED Pedalers Charter is a potentially hazardous event, and attend it out of my own free will and choice. In choosing to be part of Bubba s PAMPERED Pedalers Charter and any related events or activities, I fully accept and assume all risks, whether before, during or after Bubba s PAMPERED Pedalers Charter 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, 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 Bubba s PAMPERED Pedalers Charter 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 me or others. I understand that situations may arise during Bubba s PAMPERED Pedalers Charter that maybe 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 and to and participation in Bubba s PAMPERED Pedalers Charter 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 Bubba s PAMPERED Pedalers Charter, the staff of Bubba s PAMPERED Pedalers Charter, Bubba s Pampered Pedalers, the staff of Bubba s Pampered Pedalers, any and all sponsors, communities, organizations, Bubba s PAMPERED Pedalers Charter, Bubba s Pampered Pedalers employees-representativesvolunteers agents-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 Bubba s PAMPERED Pedalers Charter 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 Bubba s PAMPERED Pedalers Charter and its related events and activities. I agree to abide by all Bubba s PAMPERED Pedalers Charter 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 Bubba s PAMPERED Pedalers Charter 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 Bubba s PAMPERED Pedalers Charter 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 s PAMPERED Pedalers Charter 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 Bubba s PAMPERED Pedalers Charter and its related events and activities Signature (signature of parent or guardian if under 17 years of age) Print Full Name Date

5 Cancellation Policy RAGBRAI 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. Cancellation Policy: Bubba understands things happen which are out of your control. If you cancel on or before May 20, you will receive a full refund minus a $300 cancellation fee. Sorry, due to contractual obligations no refund will be offered for ANY REASON after May 20. Trip insurance is available through various carriers. Please do not ask after May 20; it just cannot happen. 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. 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. This signed form must be sent in with registration. 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:

6 RAGBRAI 2018 Bubba s Jersey Order Form Year after year, Bubba s RAGBRAI jerseys have been the best looking jerseys on RAGBRAI will be no exception. Jersey order must be mailed with Charter Registration Name: Check the appropriate box for jersey you wish: Male Female Size: (Up to 4XL) Short Sleeved Sleeveless Important information: Bicycle jersey s run small, even these jerseys. If you are unsure what size jersey you need, please stop by your local bicycle shop and try one or two to get an idea of sizing before placing your order. These jerseys are custom made so what you order will be what you must keep. It will be impossible to exchange a jersey for another jersey unless the exchange is made between two riders. Jersey orders must be received by June 1 to assure availability for RAGBRAI Yes, I want one RAGBRAI Bubba s jersey for the special price of $60 (Check here) Check payable and mailed to: Bubba Barron P.O.Box Tampa, FL I understand bicycle jerseys run small and it is my responsibility to order my proper size. I also understand and agree, the size and style I order will be the size and style I must keep. I also understand the jersey order must be received before June 1 to assure availability on RAGBRAI Print Name: Signature:

BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY

BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY Name: Male: Female Address: Age City, State & Zip: Home Number: Email Address: Cell Phone: Shirt Size Vegetarian meal