 CRUSIN’ FOR A CURE POKER RUN 2007 Sunday May 20th, 2007 REGISTRATION FORM Please print clearly: |
Last_________________________________________ First____________________________ MI _________
Address: ____________________________________City: _____________________State: _________Zip: _______
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Home Phone: __________________________E-mail ________________________ Number of hands _________
ALL PARTICIPANTS MUST SIGN RELEASE
This is a release and Indemnity Agreement – Please read before signing
I, on behalf of myself and my heirs, executors, assigns, insurers, and agents, hereby waive all my rights to sue or
make any claim whatsoever against the American Cancer Society, the promoters, sponsors and all persons, participants or
organizations conducting or connected with this event for any injury to
property, person or that I may suffer, including crippling injury or death, whether such injury arises while I am
preparing for or participating in the event or while I am in the event parameters. I know the risks to my self and my
property while participating in the event and while upon the event premise and, relying upon my own judgment and
ability assume all such risks of loss and hereby agree to reimburse all costs to those persons or organizations
connected with this event for damages incurred as a result of my negligence.
I acknowledge that the American Cancer Society is not a sponsor of this event and is not responsible for any
aspect of the organization of, or activities associated with, this event.
WE HAVE DONE EVERYTHING POSSIBLE TO PROVIDE A SAFE AND FUN EVENT FOR YOUR ENJOYMENT. IT
IS YOUR RESPONSIBILITY TO COMPLY WITH THE LAWS OF THE STATE OF MAINE. WE ARE NOT IN CONTROL
OF, NOR DO WE ACCEPT RESPONSIBILITY FOR, YOUR ACTION OR BEHAVIOR BEFORE, DURING, OR AFTER
THIS EVENT.
_________________________________________________Date:____________________________
Signature of Participant – This is a release
Form must be filled out completely and signed to be registered for the event
Bring Registration to Big Moose Harley Davidson May 20th at 10:00 am
contact phone 207-650-1065 or 207-318-5253
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FOR YOUR SAFETY AND THE SAFETY OF OTHERS, PLEASE DO NOT DRINK AND DRIVE!