"Bike 47" Registration
Bike Grand Rapids to Muskegon Lakeshore! May 19, 2012
Raise $1 per mile to send kids to Camp Michawana
Name ________________________________________ Address ________________________________________
City _____________________________ State ______ Zip _________ Phone ____________________________
Birth date__________ Age _______ Shirt size (circle) S M L XL XXL
WAIVER: I agree that Camp Michawana and sponsors of the Bike 47 are not, will not be, liable for any loss, injury, or death related to my attendance or participation in the Bike 47 trip. I know there is risk associated with this activity and I willingly accept the responsibility. I know the sole function of the above mentioned group and others is to organize the event. It is my responsibility to know and obey all laws and rules to ensure my safety. I am physically fit and able to participate. I also authorize use of my image for promotional materials for the tournament.
IMPORTANT: Each rider under 16 years of age must have a parent or adult accompanying them.
Signature _____________________________ If under 18 Parent Signature ___________________________________
How to Enter: Fill out the entry form with complete information for each player. PLEASE PRINT. *Return Completed Form to Camp Michawana 5800 Head Lake Road. Hastings, MI 49058. Parent signature is required for all riders under 18 years of age. Any questons please call (269)623-9614 or email to rvisser.michawana@gmail.com
Space is Limited Register by May 7, 2012
