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ONLINE REGISTRATION FORM One Participant Per Checkout/Form! Register for West Georgia 100, Event Date 6/06/10 Entry fee is $30.00, three dollars of which covers the online processing. $35.00 after 5/26. Event will be held rain or shine. SORRY, NO REFUNDS
Select T-Shirt Size Adult Small Adult Medium Adult Large Adult XL Adult XXL Included ONLY thru 05/26/10	Decide now if you can! Select Distance Option 12 mile bike ride 25 mile bike ride 50 mile bike ride 66 mile bike ride 100 mile bike ride Undecided
Waiver - I ACKNOWLEDGE THAT BY CHECKING THIS BOX, I AM RELEASING Promoters of the West Georgia 100 (herinafter referred to as 'event') and their RESPECTIVE AGENTS, EMPLOYEES, MEMBERS, SPONSORS, PROMOTERS AND AFFILIATES (COLLECTIVELY RELEASEES’) FROM LIABILITY. THIS ENTRY BLANK AND RELEASE IS A CONTRACT WITH LEGAL CONSEQUENCES. I HAVE BEEN ADVISED TO READ IT CAREFULLY BEFORE SIGNING. In consideration of the Releasee’s acceptance of my application for entry in the above event. I hereby freely agree to and make the following contractual representations and agreements. I acknowledge that cycling is an inherently dangerous sport and fully realize the dangers of participating in a bicycle event and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation, the following: the dangers of collision with pedestrians, vehicles, other participants, and fixed or moving objects: the dangers arising from surface hazards, equipment failure, inadequate safety equipment, THE RELEASEES’ OWN NEGLIGENCE, and weather conditions; and the possibility of serious physical and/or mental trauma or injury associated with athletic cycling and or walking. For myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest (collectively “Successors”) I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE the Releasee’s and the sponsors of this event, the organizer and any promoting organizations, property owners, law enforcement agencies, all public entities, special districts and properties, and their respective agents, officials, and employees through or by which the events will be held, (the foregoing are also collectively deemed to be Releasee’s), FROM ANY and all rights and CLAIMS INCLUDING CLAIMS ARISING FROM THE RELEASEES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association with the event, or travel to or return from the event. I agree it is my sole responsibility to be familiar with the course, the Releasee’s rules, and any special regulations for the event. I understand and agree that situations may arise during the event, which may be beyond the immediate control of the event organizers, and I must continually ride or walk so as to neither endanger myself or others. I accept responsibility for the condition and adequacy of my equipment. I will participate wearing a helmet that can protect against serious head injury, and assume all responsibility and liability for the selection of such a helmet. I have no physical or medical condition which to my knowledge, would endanger others or myself if I participate in this event, or would interfere with my ability to participate in this event. I agree, for myself and my successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert my claim in contravention of this agreement, the asserting party shall be liable for the expenses (including legal fees) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as consent to any other provision herein or as consent to any subsequent waiver or modification. Every term and provision of this agreement is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain binding and enforceable. I have read, I understand, and I agree to the above waiver. I further agree to sign waivers onsite as requested on event day and that an adult will be present to sign for me if I am 18 years old or younger.
Additional Contribution !! Not at this Time $10 Contribution $25 Contribution $50 Contribution $100 Contribution $500 Contribution $1000 Contribution (Total includes card convenience fee)	Would you like shower access? Select Shower Option Yes, please. No, thank you.
Please help us determine which of our marketing efforts work. How did you hear about the WG100? Past participant Picked up a flyer at my local bike shop Ad in SBL's Freewheelin Magazine Picked up flyer at Cheaha Challenge, Anniston AL Picked up flyer at Up the Creek, Rome GA Picked up flyer at Tour de Cure, Tyrone GA Carroll EMC Calendar Ride calendar online WG100 website (this one) Carrollton area business Carrollton area schools A friend told me about the ride Other, please indicate in following field If you selected 'Other' please elaborate Your answer here...
Participant's name is entered on Payments page.
YOU WILL RECEIVE A CONFIRMATION EMAIL/INVOICE TO PRINT AND BRING TO THE EVENT AS YOUR TICKET