Hawkeye Bicycle Association

Toledo Overnight Ride

Registration Form

July 7-8, 2007

Name ____________________________________

Address __________________________________

City ________________________ State ___________ Zip _________

Phone _________________ E-Mail _____________________________

Date of birth _________/ _______/ ___________

Emergency Contact:

Name ____________________________________

Address __________________________________

City ________________________ State ___________ Zip _________

Phone _________________

Helmet Use is Required:

Waiver (must be signed): "I do hereby for myself, heirs, executors and administrators waive any and all claims for damages and causes of action of every nature which I may have or which may hereafter accrue to me against the Hawkeye Bicycle Association, its officers or any sponsoring agencies during the participation in this event or during travel to and from this event."

Rider’s signature ___________________________________ Date: ____/______/_____

Signature of parent or guardian if rider is under 18 ______________________________

Date: ______/______/_______

  • A completed application and $20.00 fee is required of all riders
  • The form and fee must be received no later than July 2nd
  • Mail application form and fee to:

Jerry Falta
8775 Deer Crest Drive
Cedar Rapids, IA 52411-8049
  • Checks shall be made out to Hawkeye Bicycle Association
  • Questions: Call Jerry Falta at (319) 395-7212 or e-mail Jerry