BIRMINGHAM BICYCLE CLUB 30^th ANNUAL CENTURY Saturday, September 6, 2003 OFFICIAL ENTRY FORM (On-line registration available at bhambikeclub.org) NAME:___________________________________________________ ADDRESS:________________________________________________ CITY/STATE/ZIP__________________________________________ PHONE _____ ________________ EMERGENCY CONTACT (name & phone) ___________________ __________________________________________________________ AGE:________ MALE FEMALE BBC MEMBER? Y / N HAVE YOU RIDDEN THIS EVENT BEFORE? Y / N INTENDED ROUTE: (CIRCLE ONE) 20, 45, 60, 86, 100, 134, 200 T-SHIRT SIZE (OPTIONAL) S M L XL XXL XXXL ***PRE-REGISTER TO GUARANTEE SIZE*** RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN ANY WAY IN THE BIRMINGHAM BICYCLE CLUB (BBC) CENTURY, I FOR MYSELF, MY PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS AND NEXT OF KIN: 1) Acknowledge that I understand that bicycling is a strenuous and potentially hazardous activity and that I am qualified, in good health, and proper physical condition to participate in the BBC Century. I further acknowledge that the BBC Century will be conducted on public roads and facilities open to the public where the hazards of traveling are to be expected and that risks may arise from my own actions or inactions, the actions or inactions of others or the conditions in which the BBC Century takes place, and I fully accept and assume such risks and all responsibility for losses, costs and damages I incur as a result of my participation in the BBC Century. 2) Hereby release, discharge and covenant not to sue the BBC, LAB, their respective administrators, directors, agents, officers, members, volunteers and employees, other participants, sponsors, advertisers, and owners and lessors of premises on which the BBC Century takes place, from all liability, claims, demands, losses, or damage on my account. ________________________________________________________________ signature of participant date ________________________________________________________________ signature of parent or guardian if participant is under age 18 (under 16 must ride with an adult) EVERY RIDER MUST WEAR A HELMET!!!

Complete and sign this form and mail with check or money order to: Birmingham Bicycle Club P.O. Box 131163 Birmingham, AL 35213 REGISTRATION OPTIONS: PRE-REGISTER BEFORE 8/16/03………$16 T-SHIRT………………..$ 8 AFTER 8/16 (and DAY OF EVENT)…..… $20 T-SHIRT (if avail.)……$10 ***UNDER AGE 18 RIDE FOR $5***