MECCA Bicycle Club
             
Spring Festival
May 3, 4, and 5th, 2019
Green River, Utah
Amount:   $75.00   Select:   Item Subtotal:  
$0.00
T-Shirt Size
.               Registration after April 19th will increase to $95.00, with no guarantee of a t-shirt or "goody" bag.


Meal Only:   $15.00   Quantity:   Item Subtotal:  
$0.00
               Guest Meals, includes only meals - no guided rides, t-shirt, prize, etc - for guest(s) of participants.
Children 12 years old and under eat free.
Meal tickets purchased after April 19th  will be $20.
 
Additional T-Shirts:   $10.00   Quantity:   Item Subtotal:  
$0.00
T-Shirt Size [1]

T-Shirt Size

[2]

T-Shirt Size

[3]

T-Shirt Size

[4]

T-Shirt Size

[5]

T-Shirt Size

[6]

T-Shirt Size

[7]

T-Shirt Size

[8]

T-Shirt Size

[9]

T-Shirt Size

[10]
 
Total:
$0.00
Promotion Code    (Discount applied before final submission)
 
Registrant's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
ACCIDENT WAIVER AND RELEASE (AWRL) FORM
Please read the following waiver form and check the appropriate box(s) at the bottom.

I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, water conditions including pollution, temperature, currents and waves, weather, condition of athlete's equipment, vehicular traffic, actions of other people including, but not limited to participant, volunteers, spectators, coaches, event officials and event monitors, and/or procedures of the event, and lack of hydration. I hereby assume all of the  risks of participating in this event. I certify that I am physically fit, have sufficiently trained for participation in this event, and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by Huntington City Recreation and the event of holders, sponsors, and organizers, in which I may participate and that it will govern my actions and responsibilities at said events. In consideration of my application and permitting me to participate in the event, I hereby take actions for myself, my executors, administrators, and heirs, next of kin, successors, and assign as allows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from event, THE FOLLOWING ENTITIES OR PERSONS: Huntington City Recreation and its directors, officers, employees, volunteers, representative and agents, the event holders, event sponsors, event directors, event volunteers, (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event.

I hereby consent to receive medial treatment which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related actives, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and/or assigns.

This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

IF UNDER 18-PARENT/GUARDIAN WAIVER FOR MINORS

The undersigned parent and natural guardian or legal guardian does thereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of both the minor and the parents of legal guardian.

AUTHORIZED FOR MEDICAL TREATMENT
This release will authorize Emery and Green River Medical Center, Castleview Hospital, and the Emery County Ambulance Service to provide medical treatment in the event of an accident or illness while participating in the recreation programs of the Huntington City Recreation. I understand that these services are provided on fee basis.

Participant
I have read, understand, and agree to the AWRL Waiver.
*If participant is under the age of 18
Please list name of parent/guardian completing this form.
 

Payment Information
Method of Payment:
Processing Fees: Credit cards: 2.9% plus $0.30
eChecks: $0.49
Update name from Registrant's Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Registrant's Information
Cardholder's Name:
Billing ZIP/Postal Code:
For assistance, call 800-764-0844
 
MECCA Bicycle Club
P.O. BOX 491 - Huntington, UT 84528-0491
meccabikeclub@etv.net
Website - biketheswell.org
 
 
Use Instant Payments to accept payments for your business.
SIP Program & Data © 2006-2019 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
SIP Version 2.21; API: 2.7
RSI Security PCI DSS Compliance Instant Payments, Payment Processing Service, Clinton, UT Get Help